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TH
EDITION ACTUAL EXAM
WITH 100 QUESTIONS AND CORRECT
WELL ELABORATED ANSWERS
GRADED A (BRAND NEW!!)
A 4-day-old who is brought to the emergency department with the parental complaint of "not acting right" is found to be hypoglycemic. What is the appropriate glucose concentration to administer to this neonate? - ANSWER- Dextrose 10%
Rationale Dextrose 10% is the preferred concentration for neonates with hypoglycemia to protect their fragile vasculature while providing needed glucose. Dextrose 5% is not used to treat hypoglycemia in children. Dextrose 25% is used for children above the age of 5 years. Dextrose 50% is not recommended for use in pediatrics unless it is diluted.
A 14-year-old patient sustained a displaced fracture of the radius and ulna after falling from a bicycle. Which of the following pain control interventions is most likely to result in improvement in symptoms related to pain? - ANSWER-Applying a splint to the affected extremity
Rationale Splinting is an effective non-pharmacologic intervention to reduce pain associated with fractures. This will also help to minimize complications. Topical creams and elevation of the extremity will not help with pain control. The application of ice in an appropriate manner can help, but not warmth which would be contraindicated in the early stages of the injury.
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Assessment of the fontanelle provides the most useful information for which two components of the primary survey? - ANSWER-Circulation and disability
Rationale A sunken fontanelle is a red flag for circulation assessment in pediatric triage and may indicate dehydration . A bulging fontanel is a red flag for disability assessment in pediatric triage and can indicate increased intracranial pressure.
A 6-month-old is seen for a recurrent respiratory infection. During the assessment, the mother adds that the patient's stools seem to be fatty or "greasy". Which of the following disease processes would be a primary concern for this child? - ANSWER-Cystic fibrosis
Rationale In patients with cystic fibrosis, thick mucus inhibits the release of pancreatic enzymes necessary for digestion. This results in impaired absorption and the inability to utilize ingested fats. These fats are excreted in the stools and can present as "fatty" or "greasy". Combined with the recurrent upper respiratory infections for an infant, cystic fibrosis should be ruled out. The other three disease processes frequently present with respiratory issues but fatty stools would not normally be seen.
Which of the following indicates the need for additional caregiver education regarding a urinary tract infection? - ANSWER-My child will grow out of their frequent urinary tract infections.
Rationale Urinary tract infections are not a normal occurrence in children and are not something children will "grow out of." Additional investigation and follow-up are needed when a child has frequent urinary tract infections. Drinking extra fluids should be encouraged. Patients should always finish the complete course of 2 / 3
antibiotics to eliminate the infection. And follow-up should be done to make sure the infection has been eliminated.
You need to draw blood from a 2-year-old. Which of the following is the best approach for this patient? - ANSWER-Have them watch a cartoon on an I-pad or cell phone
Rationale The best approach to a toddler who requires interventions is to provide distractions whenever possible. They are in the cognitive development phase of "sensorimotor/preoperational" so having the caregiver present is helpful. You should move from the least invasive to most invasive tasks, and don't let them watch you prepare since it will increase anxiety.
The caregiver of a 2-month-old infant states the patient has had trouble breathing for the past two days. Pediatric assessment triangle (PAT) reveals an age- appropriate general appearance, rapid breathing with mild distress, and pink skin.Mucous is noted in both nares. Which of the following is the best next step? - ANSWER-Suction nasal passages using a bulb syringe
Rationale Infants up to four months old are obligate nose breathers and can have respiratory distress when nares are occluded. Mucous can be gently suctioned using a bulb syringe or suction catheter. A good, thorough history should always include immunization status for pediatric patients. The nose needs to be clear before applying oxygen via nasal cannula. Respiratory assessment includes interventions to improve breathing so you would not move to move to circulation until that is accomplished.
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