Chapter 34: Emergency Care of the Child My Nursing Test Banks

Chapter 34: Emergency Care of the Child

Test Bank

MULTIPLE CHOICE

1. Which nursing action facilitates care being provided to a child in an emergency situation?

a.

Encourage the family to remain in the waiting room.

b.

Include parents as partners in providing care for the child.

c.

Always reassure the child and family.

d.

Give explanations using professional terminology.

ANS: B

Feedback

A

Allowing the parents to remain with the child may help calm the child.

B

Include parents as partners in the childs treatments. Parents may need direct guidance in concrete terms to help distract the child.

C

Telling the truth is the most important thing. False reassurance does not facilitate a trusting relationship.

D

Professional terminology may not be understood. Speak to the child and family in language that they will understand.

PTS: 1 DIF: Cognitive Level: Application REF: p. 842

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

2. The father of a child in the emergency department is yelling at the physician and nurses. Which action is contraindicated in this situation?

a.

Provide a nondefensive response.

b.

Encourage the father to talk about his feelings.

c.

Speak in simple, short sentences.

d.

Tell the father he must wait in the waiting room.

ANS: D

Feedback

A

When dealing with parents who are upset, it is important not to be defensive or attempt to justify anyones actions.

B

Encouraging the father to talk about his feelings may assist him to acknowledge his emotions and may defuse his angry reaction.

C

People who are upset need to be spoken to with simple words (no longer than five letters) and short sentences (no more than five words).

D

Because a parent who is upset may be aggravated by observers, he should be directed to a quiet area.

PTS: 1 DIF: Cognitive Level: Application REF: p. 842

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

3. What is an appropriate nursing intervention for a 6-month-old infant in the emergency department?

a.

Distract the infant with noise or bright lights.

b.

Avoid warming the infant.

c.

Remove any pacifiers from the baby.

d.

Encourage the parent to hold the infant.

ANS: D

Feedback

A

Distraction with noise or bright lights is most appropriate for a preschool-age child.

B

In an emergency health care facility, it is important to keep infants warm.

C

Infants use pacifiers to comfort themselves; therefore the pacifier should not be taken away.

D

Parents should be encouraged to hold the infant as much as possible while in the emergency department. Having the parent hold the infant may help to calm the child.

PTS: 1 DIF: Cognitive Level: Application REF: p. 845

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

4. Which action should the nurse working in the emergency department implement in order to decrease fear in a 2-year-old child?

a.

Keep the child physically restrained during nursing care.

b.

Allow the child to hold a favorite toy or blanket.

c.

Direct the parents to remain outside the treatment room.

d.

Let the child decide whether to sit up or lie down for procedures.

ANS: B

Feedback

A

It may be necessary to restrain the toddler for some nursing care or procedures. Because toddlers need autonomy and do not respond well to restrictions, the nurse should remove any restriction or restraint as soon as safety permits.

B

Allowing a child to hold a favorite toy or blanket is comforting.

C

Parents should remain with the child as much as possible to calm and reassure her.

D

The toddler should not be given the overwhelming choice of deciding which position she prefers.

PTS: 1 DIF: Cognitive Level: Application REF: p. 844

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

5. Which nursing action is most appropriate to assist a preschool-age child in coping with the emergency department experience?

a.

Explain procedures and give the child at least 1 hour to prepare.

b.

Remind the child that she is a big girl.

c.

Avoid the use of bandages.

d.

Use positive terms and avoid terms such as shot and cut.

ANS: D

Feedback

A

Preschool-age children should be told about procedures immediately before they are done. Allowing 1 hour of time to prepare only allows time for fantasies and increased anxiety.

B

Children should not be shamed into cooperation.

C

Bandages are important to preschool-age children. Children in this age-group believe that their insides can leak out and that bandages stop this from happening.

D

Using positive terms and avoiding words that have frightening connotations assist the child in coping.

PTS: 1 DIF: Cognitive Level: Application REF: p. 845

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

6. Which action should the nurse incorporate into a care plan for a 14-year-old child in the emergency department?

a.

Limit the number of choices to be made by the adolescent.

b.

Insist that parents remain with the adolescent.

c.

Provide clear explanations and encourage questions.

d.

Give rewards for cooperation with procedures.

ANS: C

Feedback

A

Because adolescents are capable of abstract thinking, they should be allowed to make decisions about their care.

B

Adolescents should have the choice of whether parents remain with them. They are very modest, and this modesty should be respected.

C

Adolescents are capable of abstract thinking and can understand explanations. They should be offered the opportunity to ask questions.

D

Giving rewards such as stickers for cooperation with treatments or procedures is more appropriate for the younger child.

PTS: 1 DIF: Cognitive Level: Application REF: p. 844 | Box 34-1

OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

7. The emergency department nurse notices that the mother of a young child is making a lot of phone calls and getting advice from her friends about what she should do. This behavior is an indication of

a.

Stress

b.

Healthy coping skills

c.

Attention-getting behaviors

d.

Low self-esteem

ANS: A

Feedback

A

Hyperactive behavior such as making a lot of phone calls and enlisting everyones opinions is a sign of stress.

B

The behavior described is not a healthy coping skill.

C

This may be an attention-getting behavior but is more likely an indicator of stress.

D

This mother may have low self-esteem, but the immediate provocation is stress.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 846

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

8. A preschool child in the emergency department has a respiratory rate of 10 breaths per minute. How should the nurse interpret this finding?

a.

The child is relaxed.

b.

Respiratory failure is likely.

c.

This child is in respiratory distress.

d.

The childs condition is improving.

ANS: B

Feedback

A

Although the respiratory rate slows when an individual is relaxed, a rate of 10 breaths per minute in an ill preschool child is not a normal finding and is cause for concern.

B

Very slow breathing in an ill child is an ominous sign, indicating respiratory failure.

C

A rapid respiratory rate indicates respiratory distress. Other signs of respiratory distress may include retractions, grunting, and nasal flaring.

D

A respiratory rate of 10 breaths per minute is not a normal finding for a preschool child. This conclusion is incorrect.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 848

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

9. The nurse observes abdominal breathing in a 2-year-old child. What does this finding indicate?

a.

Imminent respiratory failure

b.

Hypoxia

c.

Normal respiration

d.

Airway obstruction

ANS: C

Feedback

A

A very slow respiration rate is an indicator of respiratory failure.

B

Nasal flaring with inspiration and grunting on expiration occurs when hypoxia is present.

C

Young children normally exhibit abdominal breathing. When measuring respiratory rate, the nurse should observe the rise and fall of the abdomen.

D

The child with an airway obstruction will use accessory muscles to breathe.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 848

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

10. What should be the emergency department nurses next action when a 6-year-old child has a systolic blood pressure of 58 mm Hg?

a.

Alert the physician about the systolic blood pressure.

b.

Comfort the child and assess respiratory rate.

c.

Assess the childs responsiveness to the environment.

d.

Alert the physician that the child may need intravenous fluids.

ANS: A

Feedback

A

Hypotension is a late sign of shock in children. The lower limit for systolic blood pressure for a child more than 1 year old is 70 mm Hg plus two times the childs age in years. A systolic blood pressure of 58 mm Hg calls for immediate action. The nurse should be direct in relaying the childs condition to the physician.

B

This action does not address the problem of shock, which requires immediate intervention.

C

Assessing the childs responsiveness is included in a neurologic assessment. It does not address the systolic blood pressure of 58 mm Hg.

D

Although this child most likely requires intravenous fluids, the physician must be apprised of the systolic blood pressure so that appropriate intervention can be initiated.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 854

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

11. You are the nurse caring for a child who is diagnosed with septic shock. He begins to develop an dysrhythmia and hemodynamic instability. Endotracheal intubation is necessary. The physician feels that cardiac arrest may soon develop. What drug do you anticipate the physician will order?

a.

Atropine sulfate

b.

Epinephrine

c.

Sodium bicarbonate

d.

Inotropic agents

ANS: B

Feedback

A

Atropine sulfate is used to treat symptomatic bradycardia.

B

Epinephrine is the drug of choice for the management of cardiac arrest, dysrhythmias, and hemodynamic instability.

C

Sodium bicarbonate is given to treat severe acidosis associated with cardiac arrest.

D

Inotropic agents are indicated for hypotension or poor peripheral circulation in a child.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 843

OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

12. You are the nurse working triage in the emergency department. A school-age child is brought in for treatment, carried by her mother. What is part of a primary assessment that should be performed first on this child?

a.

Determine level of consciousness.

b.

Obtain a health history.

c.

Obtain a full set of vital signs.

d.

Evaluate for pain.

ANS: A

Feedback

A

A primary assessment consists of assessing the childs airway, breathing, circulation, level of consciousness, and exposure (ABCDEs).

B

Obtaining the childs health history is a component of a secondary assessment.

C

Vital signs are included in a secondary assessment, after the ABCDEs are assessed.

D

Assessing for pain is a component of a secondary assessment.

PTS: 1 DIF: Cognitive Level: Application REF: p. 846

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

13. What is the goal of the initial intervention for a child in cardiopulmonary arrest?

a.

Establishing a patent airway

b.

Determining a pulse rate

c.

Removing clothing

d.

Reassuring the parents

ANS: A

Feedback

A

The first intervention for a child in cardiopulmonary arrest, as for an adult, is to establish a patent airway.

B

Assessment of pulse follows establishment of a patent airway.

C

Clothing may be removed from the upper body for chest compressions after a patent airway is established.

D

The first priority is to establish a patent airway.

PTS: 1 DIF: Cognitive Level: Application REF: p. 847 | Table 34-1

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

14. What is the nurses immediate action when a child comes to the emergency department with sweating, chills, and fang bite marks on the thigh?

a.

Secure antivenin therapy.

b.

Apply a tourniquet to the leg.

c.

Ambulate the child.

d.

Reassure the child and parent.

ANS: A

Feedback

A

Antivenin therapy is essential to the childs survival because the child is showing signs of envenomation.

B

The use of a tourniquet is no longer recommended.

C

When a bite or envenomation is located on an extremity, the extremity should be immobilized.

D

Envenomation is a potentially life-threatening condition. False reassurance is not helpful for building a trusting relationship.

PTS: 1 DIF: Cognitive Level: Application REF: p. 866

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

15. How should the nurse instruct the mother who calls the emergency department because her 9-year-old child has just fallen on his face and one of his front teeth fell out?

a.

Put the tooth back in the childs mouth and call the dentist right away.

b.

Place the tooth in milk or water and go directly to the emergency department.

c.

Gently place the tooth in a plastic zippered bag until she makes a dental appointment.

d.

Clean the tooth and call the dentist for an immediate appointment.

ANS: B

Feedback

A

The parent may replace the tooth incorrectly, so it is best not to advise the parent to do this.

B

The parent should be told to keep the tooth moist by placing it in a saline solution, water, milk, or a commercial tooth-preserving solution and get the child evaluated as soon as possible.

C

The tooth should be kept moist, not dry. The child should be evaluated as soon as possible.

D

Cleaning or scrubbing the tooth could damage it. It is essential for the child to have an immediate dental evaluation.

PTS: 1 DIF: Cognitive Level: Application REF: p. 871

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

16. A 3-year-old is brought to the emergency department by ambulance after her body was found submerged in the family pool. The child has altered mental status and shallow respirations. She did not require resuscitative interventions. Which condition should the nurse monitor first in this child?

a.

Neurologic status

b.

Hypothermia

c.

Hypoglycemia

d.

Hypoxia

ANS: D

Feedback

A

Although a neurologic assessment will be required, it is not the area of primary assessment. The airway is always assessed first.

B

Hypothermia offers protection to the brain. It is a concern, but not the area of primary concern.

C

Although the child may have electrolyte imbalances, this is not the primary assessment area.

D

Hypoxia is responsible for the injury to organ systems during submersion injuries. Hypoxia can progress to cardiopulmonary arrest. Monitoring the airway is always the number one concern.

PTS: 1 DIF: Cognitive Level: Analysis REF: pp. 867-868

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

17. Assessment of a child with a submersion injury focuses on which system?

a.

Cardiovascular

b.

Respiratory

c.

Neurologic

d.

Gastrointestinal

ANS: B

Feedback

A

Cardiovascular assessment is secondary to the airway and breathing.

B

Assessment of the child with a submersion injury focuses on the respiratory system. The airway and breathing are the priorities.

C

Preventing neurologic impairment is a goal of intervention. Because the primary problem in submersion injuries is hypoxia, the focus of assessment is the respiratory system.

D

Gastrointestinal assessment is less of a priority than assessment of other body systems.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 868-869

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

18. Which is the most critical element of pediatric emergency care?

a.

Airway management

b.

Prevention of neurologic impairment

c.

Maintaining adequate circulation

d.

Supporting the childs family

ANS: A

Feedback

A

Airway management is the most critical element in pediatric emergency care.

B

Prevention of neurologic impairment is certainly a concern in pediatric emergency care; however, it is not considered the most critical element.

C

Maintaining adequate circulation is accomplished after a patent airway is established.

D

The focus of emergency care is stabilizing the childs physiologic status. Supporting the family is important, but it is not considered to be the most critical element in pediatric emergency care.

PTS: 1 DIF: Cognitive Level: Application REF: p. 846, 859

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

19. Which observations made by an emergency department nurse raises the suspicion that a 3-year-old child has been maltreated?

a.

The parents are extremely calm in the emergency department.

b.

The injury is unusual for a child of that age.

c.

The child does not remember how he got hurt.

d.

The child was doing something unsafe when the injury occurred.

ANS: B

Feedback

A

The nurse should observe the parents reaction to the child but must keep in mind that people behave very differently depending on culture, ethnicity, experience, and psychological makeup.

B

An injury that is rarely found in children or is inconsistent with the age and condition of the child should raise suspicion of child maltreatment.

C

The child may not remember what happened as a result of the injury itself, for example, sustaining a concussion. Also, a 3-year-old child may not be a reliable historian.

D

The fact that the child was not supervised might be an area for health teaching. The nurse needs to gather more information to determine whether the parents have been negligent in the care of their child.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 860

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

20. In which situation is the administration of milk or water indicated after ingestion?

a.

The child is suspected of ingesting lead paint chips.

b.

The child ingested approximately 15 tablets of baby aspirin.

c.

The child ingested an over-the-counter product containing acetaminophen.

d.

The child ingested an acid or alkali.

ANS: D

Feedback

A

Ingestion of leaded paint chips does not indicate treatment with administration of water or milk.

B

Ingestion of aspirin is not treated with administration of water or milk. The treatment may involve gastric lavage with activated charcoal, IV fluids with various additives to decrease absorption, treatment of electrolyte imbalances, and vitamin K for bleeding tendencies.

C

Ingestion of acetaminophen is not treated with administration of milk or water. Gastric lavage within 1 hour and administration of the antidote N-acetylcysteine (Mucomyst) is indicated.

D

Administering water or milk can dilute the toxic effects of acid or alkali ingestion.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 864

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

21. Which initial assessment made by the triage nurse suggests that a child requires immediate intervention?

a.

The child has thick yellow rhinorrhea.

b.

The child has a frequent nonproductive cough.

c.

The childs oxygen saturation is 95% by pulse oximeter.

d.

The child is grunting.

ANS: D

Feedback

A

Nasal discharge indicates that the child has a respiratory condition but does not mean the child needs immediate attention.

B

A productive cough is not a finding that indicates that the child requires immediate attention.

C

An oxygen saturation of 95% is a normal finding.

D

One of the initial observations for triage is respiratory rate and effort. Grunting is a sign of hypoxemia and represents the bodys attempt to improve oxygenation by generating positive end-expiratory pressure.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 846

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

22. A child is brought to the emergency department. When he is called to triage, which vital sign should be measured first?

a.

Temperature

b.

Heart rate

c.

Respiratory rate

d.

Blood pressure

ANS: C

Feedback

A

Temperature should be measured after other vital signs because it can be upsetting for children.

B

Heart rate is not the first vital sign measured in children.

C

When taking childrens vital signs, the nurse observes the respiratory rate first.

D

Blood pressure is taken after other vital signs because it can be upsetting for children.

PTS: 1 DIF: Cognitive Level: Application REF: p. 849

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

23. A 2-year-old child is in the playroom. The nurse observes him picking up a small toy and putting it in his mouth. The child begins to choke. He is unable to speak. Which intervention is appropriate?

a.

Heimlich maneuver

b.

Abdominal thrusts

c.

Five back blows

d.

Five chest thrusts

ANS: A

Feedback

A

To clear a foreign body from the airway, the American Heart Association recommends the Heimlich maneuver for a conscious child older than 1 year of age.

B

Abdominal thrusts are indicated when the child is unconscious.

C

Back blows are indicated for an infant with an obstructed airway.

D

Chest thrusts follow back blows for the infant with an obstructed airway.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 852 | Table 34-3

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

24. What condition does the nurse recognize as an early sign of distributive shock?

a.

Hypotension

b.

Skin warm and flushed

c.

Oliguria

d.

Cold, clammy skin

ANS: B

Feedback

A

Hypotension is a late sign of all types of shock.

B

An early sign of distributive shock is extremities that are warm to the touch. The child with distributive shock may have hypothermia or hyperthermia.

C

Oliguria is a manifestation of hypovolemic shock.

D

Cold, clammy skin is a late sign of septic shock, which is a type of distributive shock.

PTS: 1 DIF: Cognitive Level: Application REF: p. 854 | Box 34-2

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

25. What is the leading cause of unintentional death in children younger than 19 years of age in the United States?

a.

Drowning

b.

Airway obstruction

c.

Pedestrian injury

d.

Motor vehicle injuries

ANS: D

Feedback

A

Drowning is the second leading cause of unintentional death for children under 19 years of age.

B

Airway obstruction is the third leading cause of unintentional death for children under 19 years of age.

C

Pedestrian injuries are not the leading cause of unintentional death in children. It is a significant problem, with most injuries occurring in children between 1 and 4 years.

D

The Centers for Disease Control and Prevention (CDC) has consistently found that motor vehicle injuries are the leading cause of unintentional death in children younger than 19 years of age in the United States.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 857

OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. An emergency department nurse is making a general appearance assessment on a preschool child just admitted to the emergency department. Which general assessment findings indicate the child looks bad? Select all that apply.

a.

Color pale

b.

Capillary refill less than 2 seconds

c.

Unwilling to separate from parents

d.

Cold extremities

e.

Lethargic

ANS: A, D, E

Feedback

Correct

Signs of a child looking bad on a general appearance assessment include pale skin, cold extremities, and lethargy.

Incorrect

A capillary refill of less than 2 seconds is a good sign as well as a child who is unwilling to separate from parents (separation anxiety, expected).

PTS: 1 DIF: Cognitive Level: Application REF: p. 854 | Table 34-4

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

2. What may cause hypovolemic shock in children? Select all that apply.

a.

Hyperthermia

b.

Burns

c.

Vomiting or diarrhea

d.

Hemorrhage

e.

Skin abscess that cultures positive for methicillin-resistant Staphylococcus aureus (MRSA)

ANS: B, C, D

Feedback

Correct

These are all causes of hypovolemic shock, which is characterized by an overall decrease in circulating blood or fluid volumes.

Incorrect

Neither of these is a cause of hypovolemic shock.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 853

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

COMPLETION

1. A 10-year-old girl is brought to the emergency department manifesting the following physical symptoms: sweating, nausea, headache, abdominal cramps, cool moist skin, and an elevated temperature. The childs mother reports that since this was the first warm day of summer, they spent most of the day at the beach. This patient is experiencing ___________.

ANS:

heat exhaustion

This child is experiencing a heat-related illness known as heat exhaustion. Treatment includes moving the child to a cool environment and applying cool moist cloths to the skin, removing clothing or changing her to dry clothing, elevating her legs, and offering oral rehydration fluids if no altered mental status or vomiting is evident.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 870 | Table 34-6

OBJ: Nursing Process: Diagnosis MSC: Client Needs: Physiologic Integrity

TRUE/FALSE

1. Regardless of the cause of traumatic injury, most children do well unless the injuries are extremely severe. Even children with traumatic brain injuries (TBI) have far more favorable chances of recovery than most adults. Is this statement true or false?

ANS: T

Children up to 4 years old sustain TBIs 30% more often than any other age-group, but make up the lowest number of TBI hospitalizations and deaths.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 861

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

2. Automatic external defibrillators (AEDs) are becoming increasingly more available in community settings. They are very effective for correcting serious rhythm disturbances in adults; however, they are not recommended for use in children.

ANS: F

It is now recommended that AEDs be used for infants and children as well. AEDs with high specificity in recognizing pediatric shockable rhythms and a system to decrease or attenuate delivery of shock are best used in children under 8 years of age.

PTS: 1 DIF: Cognitive Level: Application REF: p. 852

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

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