Nursing Elites

1. You are dispatched to a residence for a 5-year-old child who is not breathing. Upon arrival, you find the child supine on the floor, cyanotic, and unresponsive. You should first:

• A. begin chest compressions.
• B. open the airway and give two rescue breaths.
• C. apply an AED and analyze the rhythm.
• D. ask the parent for the child's medical history.

Correct answer: B

Rationale: When encountering an unresponsive and not breathing child, the initial step is to open the airway and provide two rescue breaths. This action helps to deliver oxygen to the child's lungs and body, which is crucial in attempting to restore breathing and circulation. Chest compressions are not initiated first in pediatric cases unless the child has no signs of circulation after delivering rescue breaths. Applying an AED and analyzing the rhythm is not the initial step in a pediatric cardiac arrest scenario, as the primary focus should be on providing oxygenation. Asking the parent for the child's medical history is not the immediate priority when the child is unresponsive and not breathing, as interventions to support breathing and circulation should be the primary concern.

2. The nurse is using the New Ballard Score to assess the gestational age of a newborn delivered 4 hours ago. The infant's gestational age is 33 weeks based on early ultrasound and last menstrual period. The nurse expects the infant to exhibit which of the following?

• A. Full sole creases, nails extending beyond the fingertips, scarf sign showing the elbow beyond the midline
• B. Testes located in the upper scrotum, rugae covering the scrotum, vernix covering the entire body
• C. Ear cartilage folded over, lanugo present over much of the body, slow recoil time
• D. 1 cm breast bud, peeling skin and veins not visible, rapid recoil of legs and arms to extension

Correct answer: C

Rationale: The correct answer is C. Ear cartilage folded over, lanugo present over much of the body, and slow recoil time are all characteristics of a preterm infant. A is incorrect because full sole creases, nails extending beyond the fingertips, and scarf sign showing the elbow beyond the midline are features of a term infant. B is incorrect as testes located in the upper scrotum, rugae covering the scrotum, and vernix covering the entire body are also indicative of a term infant. D is incorrect because a 1 cm breast bud, peeling skin and veins not visible, and rapid recoil of legs and arms to extension are characteristics seen in a more mature infant, not a preterm newborn.

3. Which of the following statements regarding pediatric anatomy is correct?

• A. The child's trachea is more rigid and less prone to collapse.
• B. The occiput is proportionately larger when compared to an adult.
• C. Airway obstruction is common in children due to their large uvula.
• D. Relative to the overall size of the airway, a child's epiglottis is smaller.

Correct answer: B

Rationale: The occiput, the back part of the head, is proportionately larger in children compared to adults, which can have implications for airway management techniques. This anatomical difference is important to consider when providing care to pediatric patients, especially during airway interventions.

4. Why should small children ride in the backseat of a vehicle?

• A. They are much less likely to be ejected from the vehicle.
• B. The back of the front seat will provide a cushion during a crash.
• C. They can experience severe injury or death if the airbag deploys.
• D. Their legs are highly prone to injury from striking the dashboard.

Correct answer: C

Rationale: Small children should ride in the backseat of a vehicle primarily to avoid severe injury or death that may occur if the airbag deploys. In the event of a crash, the force of an airbag deployment can be dangerous for a child seated in the front seat. Placing them in the backseat reduces the risk of serious harm from airbag impact and is a safer seating position for young passengers.

5. In the pediatric ward at Nyamebekyere teaching hospital, when should oxygen be applied to children?

• A. Central cyanosis
• B. Respiratory rate >70 breaths per minute
• C. Grunting noted on assessment
• D. All of the above

Correct answer: D

Rationale: All the listed conditions, central cyanosis, respiratory rate >70 breaths per minute, and grunting on assessment, are indicative of the need for oxygen therapy. Central cyanosis suggests severe hypoxemia, a respiratory rate >70 breaths per minute can indicate respiratory distress, and grunting is a sign of increased work of breathing. Administering oxygen in these situations can help improve oxygenation and support the child's respiratory function, making option D the correct choice.

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