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Assessing the carotid pulse is important for circulation, but in pediatric assessment, breathing is checked first. If the child is not breathing, interventions must begin without delay.

Accessing for emergency assistance by calling for help is critical, but since the nurse is alone and already at the scene, a rapid assessment of breathing ensures no delay in initiating life-saving support. Once responsiveness and breathing are assessed, emergency help should be activated.

Administering rescue breaths is only done after confirming that the child is not breathing. Starting rescue breaths without assessment risks providing unnecessary or inappropriate care.

Compressing the child’s chest with the palm of 1 hand is used for children (age 1–puberty), not infants. Infants require 2 fingers (single rescuer) or the 2-thumb encircling technique (two rescuers).

Obtaining an AED as soon as possible is important, but as a lone rescuer, the nurse should initiate CPR immediately first. If no help is available, CPR should be performed for about 2 minutes before leaving the infant to get an AED.

Accessing emergency assistance (call 911) as soon as possible is critical, but again, when alone with an infant who is pulseless and not breathing, CPR must be started first for 2 minutes, then the rescuer should call for help and get an AED.

30 compressions to 2 breaths ratio applies to single-rescuer CPR for children. Since there are two nurses (two rescuers), the correct ratio is 15 compressions to 2 breaths, not 30:2.

Obtain the automated external defibrillator after 2 minutes – AED use should be as soon as it becomes available, not delayed. Early defibrillation greatly improves survival in cardiac arrest.

CPR should be continued until return of spontaneous circulation (ROSC), arrival of advanced help, or when the rescuer is too exhausted to continue. Time is not fixed at 2 hours.

Informing the child to remain seated while eating is preventive advice, not an appropriate intervention in an active choking emergency.

Slapping the child five times between the shoulder blades are recommended for infants (<1 year), not for school-age children.

Standing behind the child and place both fists under the rib cage (Heimlich maneuver) is correct if the child is unable to cough, speak, or breathe, but assessment must come first.

Peer inside the child’s mouth and look for the obstruction: Only perform a visual check if the object is clearly visible. Routine inspection wastes critical time.

Insert the pinky finger into the child’s mouth and sweep the mouth: Blind finger sweeps are contraindicated in infants because they may push the object deeper and worsen obstruction.

Perform upward thrusts with fists placed under the rib cage: Abdominal thrusts (Heimlich maneuver) are not safe for infants <1 year due to risk of organ injury.

Hypotension is a late sign in pediatric hypovolemic shock, indicating decompensation and impending cardiovascular collapse.

Bradypnea is not a compensatory response; instead, children exhibit tachypnea in early shock to improve oxygen delivery. Bradypnea is a pre-terminal sign.

Cyanosis indicates severe hypoxemia and poor perfusion, occurring in advanced or decompensated shock, not during compensation.

Cardiogenic shock is caused by impaired cardiac function (e.g., myocarditis, congenital heart disease). Would present with poor perfusion plus pulmonary edema or hepatomegaly, not dehydration signs.

Distributive shock is seen in sepsis or anaphylaxis. Characterized by warm extremities, bounding pulses, and wide pulse pressure early on, not the cool extremities and dehydration signs here.

Obstructive shock is caused by physical obstruction to blood flow (e.g., cardiac tamponade, tension pneumothorax). Would not be explained by gastroenteritis and dehydration.

Oliguria is a sign of decreased renal perfusion but not the most immediate life-threatening consequence.

Arrhythmia can occur secondary to electrolyte imbalance, but it is not the primary or greatest threat in dehydration.

Hypotension is a late sign of shock; the underlying problem is circulatory collapse (shock), not just low blood pressure.

Notify the department of health is required only if the blood lead level is ≥5 µg/dL (per CDC guidelines).

Chelation therapy is recommended only for blood lead levels of ≥45 µg/dL.

Lead exposure usually occurs in the home environment (old paint, dust, contaminated soil, water), so educating the teacher is not the priority intervention.

Platelet count below 400,000 cells/mm³ is still within the normal range (150,000–400,000/mm³). Thrombocytopenia is not a primary concern with succimer.

Normal potassium levels are 3.5–5.0 mEq/L; a value above 3.5 is expected and not a side effect of succimer.

Serum sodium above 135 mEq/L is normal, not related to succimer toxicity.

Hyponatremia: Lead does not directly alter sodium balance; electrolyte abnormalities are not typical in mild lead poisoning.

Polycythemia: Lead can cause anemia, not polycythemia. It interferes with hemoglobin synthesis, leading to microcytic, hypochromic anemia.

Polyphagia: This is not associated with lead toxicity. Instead, children may develop loss of appetite, abdominal pain, or constipation at higher levels.

5 back slaps followed by 5 chest thrusts is the technique for a conscious infant with a foreign body airway obstruction, not for cardiac arrest.

Rescue breaths every 3–5 seconds is appropriate for respiratory arrest with a pulse, but this infant has no pulse, so full CPR is required.

If alone, the nurse should start CPR first for 2 minutes before activating emergency response in infants and children.