Review Practice Exercise 1

Nursing care during a pediatric emergency > Child Health

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Practice Exercise 1

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Total Questions : 5

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Question 1:

A 3-year-old is brought to the emergency department with a history of choking. The child is alert, crying loudly, and has a strong cough. What is the most appropriate nursing intervention?

A. Perform the Heimlich maneuver. B. Immediately begin CPR. C. Encourage the child to continue coughing. D. Perform a blind finger sweep.

Answer and Explanation

Choice A:

Performing the Heimlich maneuver (abdominal thrusts) is indicated only if the child is unable to cough, speak, or breathe signifying complete obstruction.

Choice B:

Immediately beginning CPR is indicated if the infant becomes unresponsive and pulseless, not while alert and crying.

Choice C:

When a child is alert and able to cough forcefully, cry, or speak, it means the airway is only partially obstructed. The safest action is to allow the child to continue coughing, because this is the body’s most effective way to expel the foreign object. Intervening too early like with back blows, abdominal thrusts, or CPR can worsen the obstruction. Continuous monitoring is essential to detect if the obstruction worsens.

Choice D:

Performing a blind finger sweep is never performed, as it can push the object further down the airway and worsen the obstruction.

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Question 2:

When performing CPR on a 7-year-old child, what is the correct compression-to-breath ratio for a single rescuer?

A. 30:2 B. 15:2 C. 5:1 D. 10:1

Answer and Explanation

Choice A:

According to the American Heart Association (AHA) guidelines, when there is only one rescuer, the compression-to-breath ratio is 30:2 for infants, children, and adults. This standardization ensures simplicity during emergencies, minimizing confusion and maximizing effectiveness.

Choice B:

15:2: This ratio applies when two rescuers are performing CPR on infants or children, not a single rescuer.

Choice C:

5:1: This is an outdated guideline, no longer recommended in pediatric CPR.

Choice D:

10:1: This is not part of current CPR recommendations.

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Question 3:

A 4-year-old child is found unresponsive and without a pulse. You are a single rescuer. After calling for help, what is your next immediate action?

A. Administer two rescue breaths. B. Check for a foreign object in the mouth. C. Begin chest compressions at a rate of 100-120 per minute. D. Perform the Heimlich maneuver.

Answer and Explanation

Choice A:

Rescue breaths are given after 30 compressions when performing CPR alone. Starting with breaths instead of compressions delays critical circulation.

Choice B:

Checking for a foreign object in the mouth through a finger sweep is not recommended unless you can see an obstruction. Wasting time searching delays CPR.

Choice C:

The AHA pediatric CPR guidelines state that if a child is pulseless and unresponsive, the rescuer should immediately begin chest compressions. Compressions should be performed at a rate of 100–120 per minute, depth of about 2 inches (5 cm), with full chest recoil. This prioritizes circulation, buying time until advanced airway and breathing support can be established.

Choice D:

Performing the Heimlich maneuver is used for choking with foreign body airway obstruction, not for an unresponsive, pulseless child.

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Question 4:

Which of the following is a critical difference between a child's respiratory system and an adult's?

A. Children have a larger lung capacity. B. Children have a smaller tongue relative to the size of the oropharynx. C. A child's trachea is longer and less flexible. D. A child's airway is narrower and more pliable.

Answer and Explanation

Choice A:

Children have smaller lung volumes, which limits oxygen reserves and contributes to quicker desaturation.

Choice B:

Children actually have a larger tongue relative to the airway, which increases the risk of obstruction.

Choice C:

The trachea in children is shorter and more flexible, contributing to airway instability and higher risk of right mainstem intubation.

Choice D:

Children’s airways are smaller in diameter and more flexible, which increases their risk of obstruction from mucus, edema, or external pressure. Their softer cartilage makes the airway more prone to collapse, particularly during respiratory distress or improper head positioning. Even a small reduction in airway diameter such as a 1 mm swelling greatly increases airway resistance in children compared to adults (Poiseuille’s law).

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Question 5:

You are a nurse performing two-rescuer CPR on a 10-month-old infant. What is the correct compression-to-breath ratio and technique?

A. 30:2, using two fingers. B. 15:2, using the two-thumb encircling hands technique. C. 30:2, using the heel of one hand. D. 15:2, using two fingers.

Answer and Explanation

Choice A:

30:2, using two fingers: This ratio is correct only for a single rescuer, not two. The two-finger method is acceptable for single-rescuer CPR when encircling is not feasible.

Choice B:

In two-rescuer infant CPR, the correct compression-to-breath ratio is 15:2. The two-thumb encircling hands technique is preferred because it produces deeper, more consistent compressions, allows for better chest recoil, and improves coronary perfusion compared to the two-finger method. This method also enables the rescuers to maintain good control of the airway and chest simultaneously.

Choice C:

30:2, using the heel of one hand: This technique is used for children (1 year to puberty), not infants. Infants require two fingers or two thumbs.

Choice D:

15:2, using two fingers: While the ratio is correct for two rescuers, the technique is not ideal. The two-finger method is less effective than the two-thumb encircling technique in generating adequate compressions.

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Practice Exercise 1

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