A 4-year-old child needs an endotracheal tube. What is the most suitable internal diameter (ID) size?

Correct Answer: A

Rationale: In pediatric nursing, selecting the appropriate endotracheal tube size is crucial to ensure proper ventilation and prevent complications. For a 4-year-old child, the most suitable internal diameter (ID) size would be A) ID 5. The rationale for choosing ID 5 is based on the age-appropriate sizing guidelines for endotracheal tubes. In general, for children around 4 years old, an ID size of 5 is commonly recommended to provide an adequate airway size without compromising on proper fit and functionality. Option B) ID 4 is too small and may lead to increased airway resistance, inadequate ventilation, and potential air leak issues. Option C) ID 7 and option D) ID 6 are larger sizes that would be inappropriate for a 4-year-old child, posing risks such as trauma to the airway, difficulty with intubation, and improper sealing within the trachea. Educationally, understanding the rationale behind selecting the correct endotracheal tube size for pediatric patients is essential for nursing students and healthcare professionals. It emphasizes the importance of considering age-specific anatomical and physiological factors when making clinical decisions to ensure safe and effective care for pediatric patients requiring airway management.

Correct Answer: D

Rationale: In pediatric nursing, performing chest compressions correctly during cardiopulmonary resuscitation (CPR) is crucial for ensuring the best outcomes for the infant. The correct answer, option D, "With 2 fingers of one hand," is based on the guidelines for infant CPR. Using two fingers allows for more precise and controlled compressions on the infant's small chest, ensuring effective circulation of blood. Option A, using the heel of one hand and the other hand on top, is incorrect as it can lead to excessive force being applied, potentially causing harm to the infant's delicate ribs and organs. Option B, using the heel of one hand only, and option C, using 4 fingers of one hand, are also incorrect as they do not provide the necessary precision and depth required for effective chest compressions on an infant. Educationally, understanding the correct technique for infant CPR is essential for healthcare professionals working in pediatric settings. By using two fingers of one hand for chest compressions, practitioners can deliver appropriate care during emergencies, potentially saving lives. Regular training and practice in infant CPR techniques are vital to ensure competency and readiness to respond effectively in critical situations involving pediatric patients.

Correct Answer: D

Rationale: In pediatric nursing, recognizing early signs of shock is crucial for timely intervention and preventing complications. The correct answer is D) Tachycardia. In pediatric patients, tachycardia is often one of the earliest signs of shock. When the body is in a state of shock, the heart rate increases as a compensatory mechanism to maintain adequate tissue perfusion. Option A) Hypotension is a late sign of shock in pediatric patients. Children can maintain their blood pressure until they are significantly hypovolemic, so hypotension is a concerning sign but not an early indicator. Option B) Disturbed consciousness level may occur in shock, but it is a later and more severe manifestation. Children typically exhibit tachycardia before alterations in consciousness. Option C) Cheyne-Stokes breathing is a pattern of breathing characterized by alternating periods of deep, rapid breathing followed by apnea. While it can occur in some conditions, it is not a specific early sign of shock in pediatric patients. Educationally, it is important for nursing students to understand the progression of shock in pediatric patients. Recognizing early signs allows for prompt intervention, which can significantly impact patient outcomes. Emphasizing the significance of tachycardia as an early indicator of shock helps students prioritize assessments and interventions in pediatric emergencies.

Correct Answer: C

Rationale: In pediatric nursing, understanding the drugs used during resuscitation is critical for providing effective care in emergency situations. The correct answer is C) Digitalis is not used during resuscitation in pediatric patients. Digitalis is a medication mainly used for heart conditions like heart failure and atrial fibrillation in adults. It is not indicated for use in pediatric resuscitation scenarios due to the potential toxicity and lack of evidence supporting its efficacy in this population. A) Atropine is used in pediatric resuscitation to treat symptomatic bradycardia. B) Bicarbonate may be used in cases of metabolic acidosis or certain poisonings. D) Epinephrine is a key medication in pediatric resuscitation for managing cardiac arrest and severe allergic reactions. Educationally, understanding the appropriate medications for pediatric resuscitation helps nurses make quick and accurate decisions to optimize patient outcomes. It is essential for nurses to be familiar with the indications, dosages, and potential side effects of these medications to provide safe and effective care to pediatric patients in critical situations.

Correct Answer: D

Rationale: In this case, the correct answer is D) Metabolic alkalosis without compensation. To understand why this is the correct interpretation of the ABG results, let's break it down: 1. pH: 7.48 - The pH is elevated, indicating alkalosis. 2. PaCO2: 42 - The PaCO2 is within normal range (35-45 mmHg), indicating that there is no primary respiratory acidosis or alkalosis. 3. HCO3: 30 - The HCO3 level is elevated, indicating metabolic alkalosis. Therefore, the ABG results show a high pH and high bicarbonate level without any significant compensation from the respiratory system, suggesting a primary metabolic alkalosis without any respiratory component. Now, let's analyze why the other options are incorrect: A) Metabolic acidosis without compensation: This is incorrect because the pH is elevated, not decreased, and the HCO3 level is high, indicating alkalosis, not acidosis. B) Respiratory alkalosis with partial compensation: This is incorrect because there is no significant decrease in PaCO2 to indicate respiratory alkalosis, and the HCO3 level is high, indicating metabolic alkalosis. C) Respiratory alkalosis with full compensation: This is incorrect because there is no significant decrease in PaCO2 to indicate respiratory alkalosis, and the HCO3 level is high, indicating metabolic alkalosis. Educational context: Understanding how to interpret ABG results is crucial in pediatric nursing as it helps in identifying and managing various acid-base imbalances in pediatric patients. It is essential for nurses to be able to differentiate between respiratory and metabolic imbalances and understand the compensatory mechanisms involved. This knowledge is vital for providing safe and effective care to pediatric patients with complex health needs.