LPN LPN
LPN Pediatrics
1. A 4-year-old boy with a tracheostomy tube is experiencing respiratory distress. He has intercostal retractions, a heart rate of 80 beats/min, and an oxygen saturation of 85%. During his attempts to breathe, a gurgling sound is heard in the tracheostomy tube. You should:
- A. Ventilate through the tracheostomy tube.
- B. Place an oxygen mask over the tracheostomy tube.
- C. Remove the tracheostomy tube and clean it.
- D. Carefully suction the tracheostomy tube.
Correct answer: D
Rationale: In this scenario, the 4-year-old boy with a tracheostomy tube is showing signs of respiratory distress, including intercostal retractions, a low heart rate, and decreased oxygen saturation. The gurgling sound indicates a possible airway obstruction. Correctly, the immediate action should be to carefully suction the tracheostomy tube. Suctioning can help clear any secretions or obstructions, thus improving the child's ability to breathe effectively. Ventilating through the tube, placing an oxygen mask over it, or removing and cleaning the tube would not address the potential obstruction and could worsen the respiratory distress.
2. A 3-year-old female presents with respiratory distress. She is conscious, crying, and clinging to her mother. She has mild intercostal retractions and an oxygen saturation of 93%. The MOST effective way of delivering oxygen to her involves:
- A. gently restraining her and assisting with ventilations.
- B. ventilations with a flow-restricted, oxygen-powered device.
- C. a non-rebreathing mask with the flow rate set at 6 to 8 L/min.
- D. asking the mother to hold an oxygen mask near her face.
Correct answer: C
Rationale: In a pediatric patient with respiratory distress, a non-rebreathing mask with a flow rate set at 6 to 8 L/min is the most effective way to deliver oxygen. This method ensures a high concentration of oxygen is delivered to the child, aiding in improving oxygen saturation levels. In this scenario, the mother can assist in holding the mask to maintain comfort and cooperation in the child while ensuring proper oxygen delivery.
3. During the 5-minute Apgar assessment of a newborn, you note a heart rate of 130 beats/min, cyanosis in the hands and feet, and rapid respirations. The baby cries when you flick the soles of its feet and resists leg straightening. These findings correspond to an Apgar score of:
- A. 9
- B. 7
- C. 8
- D. 10
Correct answer: A
Rationale: The Apgar score is a rapid assessment tool to evaluate the newborn's transition to life outside the womb. The Apgar score is based on five components: heart rate (>100 bpm), respiratory effort (rapid breathing), muscle tone (resisting leg straightening), reflex irritability (crying when feet are flicked), and color (cyanosis to extremities). The described findings match a score of 9, indicating good overall condition and adaptation to extrauterine life.
4. When is it MOST appropriate to clamp and cut the umbilical cord?
- A. Before the newborn has taken its first breath
- B. After the placenta has completely delivered
- C. As soon as the cord has stopped pulsating
- D. Immediately following delivery of the newborn
Correct answer: C
Rationale: The ideal time to clamp and cut the umbilical cord is when it has stopped pulsating. This allows for the transfer of remaining blood from the placenta to the newborn, which can be beneficial for the baby's health and iron stores. Clamping the cord too early can deprive the newborn of this essential blood volume. Waiting for the pulsations to cease ensures that the baby receives the maximum benefits from delayed cord clamping.
5. When performing CPR on an infant with suspected sudden infant death syndrome (SIDS), an important aspect to consider is:
- A. Focusing all of your attention on the infant, with minimal parental interaction.
- B. Carefully inspecting the environment in which the infant was found.
- C. Understanding that most infants with SIDS can be successfully resuscitated.
- D. Encouraging the presence of the parents during your resuscitation attempt.
Correct answer: B
Rationale: When dealing with a suspected case of SIDS, it is crucial to carefully inspect the environment in which the infant was found. This inspection can provide valuable information that may help determine the cause and support further investigation into the incident. By examining the surroundings, potential hazards or clues related to the sudden event may be identified, aiding in understanding the circumstances and potentially preventing similar incidents in the future.
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