Review Practice Exercise 2

Nursing care during a pediatric emergency > Child Health

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Practice Exercise 2

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Total Questions : 5

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Question 1:

A 3-year-old is seen in the clinic at 8:30 pm with a history of vomiting for 2 days and poor oral intake; he has voided once since the previous day. Examination reveals a lethargic child sitting on the mother’s lap. He has a capillary refill of 4 seconds, apical heart rate 128, respiratory rate of 32, and poor skin turgor. State body weight is 25 kg. Based on this information, the nurse anticipates performing which of the following?

A. Demonstrating to the mother how to give 5 to 10 ml of Pedialyte by mouth every 5 to 10 minutes. B. Administering an intravenous fluid bolus of 450 ml of 5% dextrose in water over 60 minutes. C. Administering an intravenous fluid bolus of 500 ml of 0.9% normal saline over 20 minutes. D. Administering an intravenous fluid bolus of 1000 ml of 5% dextrose and 0.45% normal saline over 30 minutes.

Answer and Explanation

Choice A:

Oral rehydration (Pedialyte) is appropriate for mild/moderate dehydration, but this child is too lethargic and hemodynamically unstable for oral intake.

Choice B:

5% Dextrose in water (D5W) is a hypotonic solution; not used for bolus resuscitation. Risk of cerebral edema and hyponatremia.

Choice C:

The child shows signs of severe dehydration with hypovolemic shock (tachycardia, delayed cap refill, lethargy, poor urine output). The correct intervention is an IV bolus of isotonic crystalloid (0.9% NS or LR), 20 mL/kg, over ~20 minutes. For a 25-kg child: 20 mL/kg × 25 = 500 mL NS. This restores intravascular volume rapidly and prevents progression to shock.

Choice D:

1000 mL D5 0.45% NS is too large a volume for bolus in a 25-kg child and contains dextrose + hypotonic fluid, which is unsafe for initial resuscitation.

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Question 2:

A 6-year-old is brought to the ED after a bicycle accident. You notice cool, pale extremities, a prolonged capillary refill of 4 seconds, and a weak, thready peripheral pulse. His blood pressure is within normal limits for his age. What stage of shock is he most likely in?

A. Decompensated shock B. Irreversible shock C. Compensated shock D. Cardiogenic shock

Answer and Explanation

Choice A:

Decompensated shock occurs when compensatory mechanisms fail resulting in hypotension. Since BP is still normal here, this is not decompensated shock.

Choice B:

Irreversible shock is the final stage with profound acidosis, cellular injury, organ failure, and death, not consistent with this presentation.

Choice C:

Compensated shock refers to impaired perfusion with normal blood pressure. Findings include: cool, pale extremities, delayed capillary refill (>3 seconds), weak/thready peripheral pulses, tachycardia. The body is maintaining perfusion to vital organs through vasoconstriction, but early warning signs are present. This child’s normal BP + poor perfusion signs indicates compensated shock.

Choice D:

Cardiogenic shock is caused by pump failure such as congenital heart disease and myocarditis. It would present with signs of poor perfusion plus pulmonary congestion or hepatomegaly, not seen here.

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Question 3:

A nurse is caring for a 3½-year-old child who consumed a bottle of aspirin 10 minutes earlier.

Which of the following findings would the nurse expect to see?

A. Hyperglycemia B. Hyperpnea C. Hyperthermia D. Hypernatremia

Answer and Explanation

Choice A:

Hyperglycemia: Aspirin poisoning is more often associated with hypoglycemia due to increased metabolic demand.

Choice B:

Hyperpnea: Salicylates stimulate the medullary respiratory center, leading to rapid, deep breathing. This results in respiratory alkalosis in the early phase of poisoning.

Choice C:

Hyperthermia: Can occur in severe toxicity due to increased metabolic activity, but it is not an early or expected initial finding.

Choice D:

Hypernatremia: Salicylate poisoning is not associated with sodium imbalance; dehydration may occur, but not hypernatremia as a primary effect.

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Question 4:

When treating a child in hypovolemic shock, what is the recommended initial fluid bolus?

A. 5 mL/kg of D5W B. 20 mL/kg of an isotonic crystalloid C. 10 mL/kg of a hypotonic solution D. 30 mL/kg of a colloid solution

Answer and Explanation

Choice A:

Dextrose-containing solutions are hypotonic once metabolized, and they do not remain in the intravascular space. They risk worsening cerebral edema in shock.

Choice B:

The recommended initial bolus for children in hypovolemic shock is 20 mL/kg of an isotonic crystalloid (Normal Saline or Ringer’s Lactate). Administered rapidly (over 5–10 minutes) and reassessed after each bolus. Isotonic crystalloids expand intravascular volume effectively, restoring perfusion without causing fluid shifts that worsen edema.

Choice C:

Hypotonic fluids such as 0.45% NS move into cells, not the intravascular space, and are dangerous in shock.

Choice D:

Colloids such as albumin and starches are not first-line in children; crystalloids are safer, cheaper, and equally effective.

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Question 5:

A preschool child was administered activated charcoal in the emergency department after a poisoning event. The child is being discharged home. Which of the following adverse reactions to the medication should the parent be advised to report to the child’s primary health-care provider?

A. Rash B. Conjunctivitis C. Lethargy D. Constipation

Answer and Explanation

Choice A:

A Rash is not a typical side effect of activated charcoal.

Choice B:

Conjunctivitis is not associated with activated charcoal therapy.

Choice C:

Lethargy could relate to poisoning itself but not a direct adverse effect of activated charcoal.

Choice D:

Constipation is the most concerning adverse effect of activated charcoal, as it may progress to bowel obstruction or ileus. Parents should monitor for abdominal pain, distension, or absent bowel movements and notify the provider immediately if these occur.

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Practice Exercise 2

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