A 4-year-old presents with vomiting, lethargy, frequent urination, weight loss, and dry mucous membranes. Vital
signs reveal deep respirations at 44 breaths per minute, BP of 70/44 mm Hg, and HR of 144 beats per minute.
Which of the following laboratory values would be most expected in this child?
Hypoglycemia (wrong)
Remediation feedback:
Children can present with new onset diabetes in diabetic ketoacidosis. Manifestations include signs of
dehydration ( dry mucous membranes, hypotension, tachycardia), incontinence (polyuria), vomiting, abdominal
pain, Kussmaul respirations (to counter the acidosis), polydipsia, anorexia, and weight loss. Expected laboratory
values would reveal an acidotic state with a pH level below 7.3, an elevated serum bIcarbonate level, and an
elevated blood glucose level > 200 mg.dL.
An 18-month-old is seen for fever, slight circumoral cyanosis, and wheezing noted on auscultation in the right
upper lobe of the lung field after a choking event 4 days ago. The white blood cell count is elevated and the
patient noted to be tachypneic, tachycardic, agitated, and has an increased respiratory effort. At the time of the
event, the patient was started on antibiotics with subsequent increasing manifestations instead of improvement.
Which of the following would be considered to be definitive treatment for the suspected diagnosis?
The definitive treatment would be a bronchoscopy in order to retrieve the suspected foreign body instead of
diagnostic tests to locate the foreign body itself.
,A child in cardiopulmonary arrest is receiving chest compressions and manual ventilations with a bag-mask
device. Once return of spontaneous circulation has been confirmed, which of the following would be the priority
intervention?
Establishing a secure airway
Parents report their 3-year-old child has developed noisy breathing. On assessment, high-pitched wheezes are
audible and auscultated on inspiration and expiration. What medication would be appropriate to administer first?
initial medication intervention includes an inhaled short-acting beta agonist.
A 6-week-old is brought to the emergency department by the caregivers for poor feeding, listlessness, and fever.
Assessment reveals a crying infant, HR 160 beats/minute, RR 52 breaths/minute, rectal temperature of 96.0 F
(35.5 C), and a bulging anterior fontanel. Capillary refill is 4 seconds. Based on these findings what is the most
likely diagnostic test the nurse should anticipate?
Lumbar puncture
,A 12-year-old is being prepped for surgical intervention of acute appendicitis. Which of the following
intravenous medication orders should the nurse question?
Ketorolac
Remediation feedback:
Ketorolac is an appropriate medication for moderate to severe pain, however, it should not be used pre-
operatively due to its potential to increase the bleeding risk.
A 17-year-old female arrives in the ED with her boyfriend who states she is pregnant and having vaginal
bleeding. The patient is unsure of the gestational age and has not had any prenatal treatment. The patient is quiet
and lets her boyfriend answer most of the questions. Which of the following is the most appropriate action for the
nurse to take at this point?
Have the boyfriend leave the room during the pelvic exam.
A 2-year-old arrives at the ED in hypovolemic shock and needs fluids immediately. After several attempts, your
team has been unsuccessful at establishing vascular access. Of the following, which is the next best option for
establishing access quickly?
Intraosseous in the patient's medial tibia.
, A child with an electrical injury is seen 1 hour post event. Which of the following types of specimen samples
would provide visual information regarding a potential complication of this injury?
Myoglobin is excreted in the urine and is evidenced by dark, red-tinged urine.
Parents with an infant requiring multiple laboratory tests, radiographic studies, and invasive procedures appear to
be distressed and withdrawn. Which of the following interventions would best ensure a sense of comfort and
control for these parents?
Providing frequent updates and re-educating them on the care that is being provided
When taking vital signs on a stable infant, which of the following should be done first?
Respiratory rate
A laceration on a toddler's arm is prepared for suturing. Which of the following preparations for topical
anesthesia would be the best choice for this procedure?
LET (lidocaine/epinephrine/tetracaine)
Which of the following is appropriate administration of N-acetylcysteine (NAC) for an acetaminophen overdose?
A bolus infusion of 150 mg/kg NAC should be administered.
signs reveal deep respirations at 44 breaths per minute, BP of 70/44 mm Hg, and HR of 144 beats per minute.
Which of the following laboratory values would be most expected in this child?
Hypoglycemia (wrong)
Remediation feedback:
Children can present with new onset diabetes in diabetic ketoacidosis. Manifestations include signs of
dehydration ( dry mucous membranes, hypotension, tachycardia), incontinence (polyuria), vomiting, abdominal
pain, Kussmaul respirations (to counter the acidosis), polydipsia, anorexia, and weight loss. Expected laboratory
values would reveal an acidotic state with a pH level below 7.3, an elevated serum bIcarbonate level, and an
elevated blood glucose level > 200 mg.dL.
An 18-month-old is seen for fever, slight circumoral cyanosis, and wheezing noted on auscultation in the right
upper lobe of the lung field after a choking event 4 days ago. The white blood cell count is elevated and the
patient noted to be tachypneic, tachycardic, agitated, and has an increased respiratory effort. At the time of the
event, the patient was started on antibiotics with subsequent increasing manifestations instead of improvement.
Which of the following would be considered to be definitive treatment for the suspected diagnosis?
The definitive treatment would be a bronchoscopy in order to retrieve the suspected foreign body instead of
diagnostic tests to locate the foreign body itself.
,A child in cardiopulmonary arrest is receiving chest compressions and manual ventilations with a bag-mask
device. Once return of spontaneous circulation has been confirmed, which of the following would be the priority
intervention?
Establishing a secure airway
Parents report their 3-year-old child has developed noisy breathing. On assessment, high-pitched wheezes are
audible and auscultated on inspiration and expiration. What medication would be appropriate to administer first?
initial medication intervention includes an inhaled short-acting beta agonist.
A 6-week-old is brought to the emergency department by the caregivers for poor feeding, listlessness, and fever.
Assessment reveals a crying infant, HR 160 beats/minute, RR 52 breaths/minute, rectal temperature of 96.0 F
(35.5 C), and a bulging anterior fontanel. Capillary refill is 4 seconds. Based on these findings what is the most
likely diagnostic test the nurse should anticipate?
Lumbar puncture
,A 12-year-old is being prepped for surgical intervention of acute appendicitis. Which of the following
intravenous medication orders should the nurse question?
Ketorolac
Remediation feedback:
Ketorolac is an appropriate medication for moderate to severe pain, however, it should not be used pre-
operatively due to its potential to increase the bleeding risk.
A 17-year-old female arrives in the ED with her boyfriend who states she is pregnant and having vaginal
bleeding. The patient is unsure of the gestational age and has not had any prenatal treatment. The patient is quiet
and lets her boyfriend answer most of the questions. Which of the following is the most appropriate action for the
nurse to take at this point?
Have the boyfriend leave the room during the pelvic exam.
A 2-year-old arrives at the ED in hypovolemic shock and needs fluids immediately. After several attempts, your
team has been unsuccessful at establishing vascular access. Of the following, which is the next best option for
establishing access quickly?
Intraosseous in the patient's medial tibia.
, A child with an electrical injury is seen 1 hour post event. Which of the following types of specimen samples
would provide visual information regarding a potential complication of this injury?
Myoglobin is excreted in the urine and is evidenced by dark, red-tinged urine.
Parents with an infant requiring multiple laboratory tests, radiographic studies, and invasive procedures appear to
be distressed and withdrawn. Which of the following interventions would best ensure a sense of comfort and
control for these parents?
Providing frequent updates and re-educating them on the care that is being provided
When taking vital signs on a stable infant, which of the following should be done first?
Respiratory rate
A laceration on a toddler's arm is prepared for suturing. Which of the following preparations for topical
anesthesia would be the best choice for this procedure?
LET (lidocaine/epinephrine/tetracaine)
Which of the following is appropriate administration of N-acetylcysteine (NAC) for an acetaminophen overdose?
A bolus infusion of 150 mg/kg NAC should be administered.
