JeopardyEmergency Care

The Ill Child

Chronically Ill Child

Principles and Procedures

Medicating Infants

Q $100

Q $200

Q $300

Q $400

Q $500

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Q $300 Q $300 Q $300 Q $300

Q $400 Q $400 Q $400 Q $400

Q $500 Q $500 Q $500 Q $500

Final Jeopardy

$100 Question from H1

Which is the most critical element of pediatric emergency care?a)Airway managementb)Maintaining adequate circulationc)Prevention of neurologic impairmentd)Supporting the child’s family

$100 Answer from H1

a)Airway management

$200 Question from H1

A child is brought to the emergency department. When he is called to triage, which vital sign should be measured first?a)Temperatureb)Respiratory ratec)Heart rated)Blood pressure

$200 Answer from H1

b)Respiratory rate

$300 Question from H1You are the nurse caring for a child who is diagnosed with septic shock. He begins to develop an arrhythmia 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 sulfateb)Epinephrinec)Sodium bicarbonated)Dopamine

$300 Answer from H1

B) Epinephrine is the drug of choice for the management of cardiac arrest, arrhythmias, and hemodynamic instability

$400 Question from H1What should be the emergency department nurse’s 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 child’s responsiveness to the environment.d)Alert the physician that the child may need intravenous fluids.

$400 Answer from H1

A )Hypotension is a late sign of shock in children. The lower limit for systolic blood pressure for a child older than 1 year is 70 mm Hg plus two times the child’s age in years.

$500 Question from H1A 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. The nurse is most concerned about monitoring for which of the following first in this child?a)Neurologic statusb)Hypothermiac)Hypoglycemiad)Hypoxia

$500 Answer from H1

d)Hypoxia

$100 Question from H2What is the best explanation for a 2-year-old child who is quiet and withdrawn on the fourth day of a hospital admission?a.The child is protesting her separation from her caregivers.b.The child has adjusted to the hospitalization.c.The child is experiencing the despair stage of separation.d.The child has reached the stage of detachment.

$100 Answer from H2

C )In the despair stage of separation, the child exhibits signs of hopelessness and becomes quiet, withdrawn, and apathetic.

$200 Question from H2Which intervention would help a hospitalized toddler feel a sense of control?a)Assign the same nurses to care for the child.b)Put a cover over the child’s crib.c)Require parents to stay with the child.d)Follow the child’s usual routines for feeding and bedtime.

$200 Answer from H2

d)Follow the child’s usual routines for feeding and bedtime

$300 Question from H2

What is the best action for the nurse to take when a 5-year-old child who requires another 2 days of IV antibiotics cries, screams, and resists having his IV restarted?a)Exit the room and leave the child alone until he stops crying.b)Tell the child big boys and girls “don’t cry.”c)Let the child decide which color arm board to use with his IV.d)Administer a narcotic analgesic for pain to quiet the child.

$300 Answer from H2

C )Giving the preschooler some choice and control, while maintaining boundaries of treatment, supports the child’s coping skills

$400 Question from H2

A 3 -year-old child who is toilet trained has had several “accidents” since hospital admission. What is the nurse’s best action in this situation?a)Find out how long the child has been toilet trained at home.b)Encourage the parents to scold the child.c)Explain how to use a bedpan and place it close to the child.d)Follow home routine of elimination.

$400 Answer from H2

d)Follow home routine of elimination.

$500 Question from H2Which is the most developmentally appropriate intervention when working with the hospitalized adolescent?a.Encourage peers to call and visit when the adolescent’s condition allows.b.Encourage the adolescent’s friends to continue with their daily activities; the adolescent has concrete thinking and will understand.c.Discourage questions and concerns about the effects of the illness on the adolescent’s appearance.d.Ask the parents how the adolescent usually copes in new situations.

$500 Answer from H2

A )The peer group is important to the adolescent’s sense of belonging and identity; therefore separation from friends is a major source of anxiety for the hospitalized adolescent

$100 Question from H3How can chronic illness and frequent hospitalizations affect the psychosocial development of a toddler?a. They can create a distortion of differentiation of self from parent.b. They can interfere with the development of autonomy.c. They can interfere with the acquisition of language, fine motor, and self-care skills.d. They can create feelings of inadequacy.

$100 Answer from H3

B) Chronic illness may interfere in the development of autonomy, which is the major psychosocial task of the toddler.

$200 Question from H3What is the priority goal for the child with a chronic illness?a. To maintain the intactness of the familyb. To eliminate all stressorsc. To achieve complete wellnessd. To obtain the highest level of wellness

$200 Answer from H3

D) To obtain the highest level of health and function possible is the priority goal of nursing of children

$300 Question from H3What would the nurse identify as major fears in the preschool child who is hospitalized with a chronic illness? (Choose all that apply.)a. Altered body imageb. Separation from peer groupc. Bodily injuryd. Mutilatione. Being left alone

$300 Answer from H3

ANS: C, D, ECorrect C, D, E. These are all major fears of the preschooler.Incorrect A, B. These are major fears in the adolescent.

$400 Question from H3

Many parents who have children diagnosed with a chronic illness experience recurrent feelings of grief, loss, and fear related to the child’s condition and loss of the ideal healthy child. The nurse recognizes this process as:a. Anticipatory grievingb. Bereavementc. Chronic sorrowd. Illness trajectory

$400 Answer from H3

B )The stated recurrent feelings define chronic sorrow, which is considered a normal process involving grief that may never be resolved.

$500 Question from H3

You are counseling the family of a 12-month-old child who has lost his mother in a car accident. How would you explain to the father what the child’s understanding of death is, related to theories of growth and development?a. Temporaryb. Loss of caretakerc. Permanentd. Punishment

$500 Answer from H3

b)This is the infant/toddler understanding of death

$100 Question from H4The nurse knows that measuring temperature is an integral part of assessment. Which concept is important for the nurse to know when taking a child’s temperature?a. The method used should be consistent.b. Rectal temperatures should always be taken on infants.c. Oral temperatures can be taken on all children older than 5 years of age.d. Axillary temperatures should be taken at night.

$100 Answer from H4

A The method that is determined most appropriate for the child should be used consistently—the same site and device to maintain consistency and allow reliable comparison and tracking of temperatures over time.

$200 Question from H4

What information would the nurse include in teaching parents how to care for a child’s gastrostomy tube at home?a. Never turn the gastrostomy button.b. Clean around the insertion site daily with soap and water.c. Expect some leakage around the button.d. Remove the tube for cleaning once a week.

$200 Answer from H4

B The skin around the tube insertion site should be cleaned with soap and water once or twice daily.

$300 Question from H4

Which finding is the most reliable method that would indicate the end of a nasogastric tube is placed correctly?a. Swallowing, coughing, and gagging reflex are intact.b. The pH of aspirated fluid is 5 or lower.c. The fluid has a grassy green appearance.d. Insufflation of air is auscultated over the epigastrium.

$300 Answer from H4

B )The pH of fluid aspirated from the stomach should be 5 or lower. This is the most reliable method for indication that a nasogastric tube is properly placed.

$400 Question from H4

$400 Answer from H4

.b. Make sure the mask fits properly.

$500 Question from H4

What is appropriate to include in the care plan for a family of a child with a tracheostomy?a. Suction of the tracheostomy every 2 to 4 hours or as neededb. Application of powder around the stoma to decrease irritationc. Suction catheter insertion limited to less than 30 secondsd. Hygiene that includes showers, not baths

$500 Answer from H4

A )To maintain a patent airway in a child with a tracheostomy, assessing respiratory status and suctioning every 2 to 4 hours or as needed using Standard Precautions is an important intervention to teach families

$100 Question from H5Which factor should the nurse remember when administering topical medication to an infant as compared to an adolescent?a. Infants require a larger dosage because of a greater body surface area.b. Infants have a thinner stratum corneum that absorbs more medication.c. Infants have a smaller percentage of muscle mass.d. The skin of infants is less sensitive to allergic reactions.

$100 Answer from H5

B)Infants and young children have a thinner outer skin layer (stratum corneum), which increases the absorption of topical medication.

$200 Question from H5

What would the nurse use to prepare liquid medication in volumes less than 5 mL?a. Calibrated syringeb. Plastic measuring cupc. Paper measuring cupd. Household teaspoon

$200 Answer from H5

a) To ensure accuracy, a calibrated syringe without a needle should be used to prepare a liquid dosage less than 5 mL

$300 Question from H5Which physiologic difference would affect the absorption of oral medications administered to a 3-month-old infant?a. More rapid peristaltic activity b. Usually more rapid gastric emptyingc. More acidic gastric secretionsd. Variable pancreatic enzyme activity

$300 Answer from H5

D )Pancreatic enzyme activity is variable in infants for the first 3 months of life as the gastrointestinal system matures. Medications that require specific enzymes for dissolution and absorption might not be digested to a form suitable for intestinal action.

$400 Question from H5

What is the maximum safe volume that a neonate can receive in an intramuscular injection?a.0.25 mLb.0.5 mLc.1 mLd.1.5 mLe.None of the above

$400 Answer from H5

B The maximum volume of medication for an intramuscular injection to a neonate is 0.5 mL.

$500 Question from H5What action indicates that a school-age child is using a metered-dose inhaler correctly?a. The child uses his inhaled steroid before the bronchodilator.b. The child exhales forcefully as he squeezes the inhaler.c. The child holds his breath for 10 seconds after the first puff.d. The child waits 10 minutes before taking a second puff.

$500 Answer from H5

C) After a puff the child should hold his breath for about 10 seconds or until he counts slowly to 5.

Final Jeopardy

What nursing action is indicated when a child receiving a unit of packed red blood cells complains of chills, headache, and nausea?a. Continue the infusion and take the child’s vital signs.b. Stop the infusion immediately and notify the physician.c. Slow the infusion and assess for cessation of symptoms.d. Start a dextrose solution and stay with the child.

Final Jeopardy Answer

B) If a reaction is suspected, as in this case, the transfusion is stopped immediately and the physician is notified