A head-injured 4-year-old patient opens eyes to painful stimulus, is confused, and withdraws from pain. His Glasgow Coma Score is:

Correct Answer: B

Rationale: In this scenario, the correct answer is B) 10. The Glasgow Coma Scale (GCS) assesses the level of consciousness in a patient with a head injury. A GCS score of 10 indicates that the patient is opening their eyes to pain stimulus, confused in their responses, and withdrawing from pain, which aligns with the patient's presentation in the question. Option A) 8 is incorrect because a GCS score of 8 would indicate a more severe level of neurological compromise, such as not opening eyes to pain or having a more limited response to stimuli compared to the patient described in the question. Option C) 11 is incorrect because a GCS score of 11 would typically involve a higher level of consciousness and more appropriate responses than what the patient in the question is exhibiting. Option D) 13 is incorrect as it would suggest a near-normal level of consciousness and responsiveness, which is not consistent with the patient's presentation of being confused and withdrawing from pain. Educationally, understanding the GCS is crucial for nurses caring for pediatric patients, especially in emergency and critical care settings. It helps in assessing the severity of head injuries, guiding treatment decisions, and monitoring changes in neurological status over time. Nurses must be able to accurately interpret GCS scores to provide appropriate care and communicate effectively with the healthcare team.

Correct Answer: B

Rationale: In pediatric nursing, it is crucial to understand the signs and symptoms of circulatory failure to provide prompt and effective care to children. In this question, option B, "Marked tachypnea with recessions," is the correct answer as it is a sign of respiratory distress rather than circulatory failure. Tachypnea with retractions typically indicates increased work of breathing and points towards a respiratory issue rather than a circulatory problem. Option A, "Cyanosis despite supplied O2," is indicative of poor oxygenation despite oxygen therapy, which is a sign of circulatory compromise. Cyanosis results from inadequate oxygen delivery to tissues and can be a manifestation of circulatory failure. Option C, "Gallop rhythm/murmur," and Option D, "Enlarged tender liver," are also signs of circulatory compromise. A gallop rhythm or murmur can indicate cardiac dysfunction, while an enlarged tender liver can be a sign of congestive heart failure or hepatic congestion due to circulatory issues. Educationally, understanding these distinctions is vital for nurses caring for pediatric patients. Recognizing the specific signs of circulatory failure versus respiratory distress can guide appropriate interventions and help prevent further deterioration in a child's condition. It is essential to differentiate between these clinical manifestations to provide targeted and effective care in a pediatric healthcare setting.

Correct Answer: B

Rationale: Anaphylactic shock is a potentially life-threatening condition that requires immediate recognition and intervention. The correct answer is B) Decreased systemic vascular resistance. In anaphylactic shock, there is a widespread vasodilation leading to decreased systemic vascular resistance. This results in a rapid drop in blood pressure and impaired tissue perfusion, which can lead to organ damage and failure. Option A) Airway obstruction is a common feature of anaphylactic shock but is not the defining characteristic. While airway obstruction can occur due to swelling of the airways, it is not the primary mechanism of anaphylactic shock. Option C) Generalized vasoconstriction is incorrect as anaphylactic shock is characterized by vasodilation rather than vasoconstriction. Vasoconstriction would increase vascular resistance, not decrease it as seen in anaphylactic shock. Option D) Hypovolemia is also incorrect as anaphylactic shock is not primarily due to a decrease in blood volume. It is more related to the systemic vasodilation and increased vascular permeability leading to fluid shifting into tissues rather than hypovolemia. Educationally, understanding the pathophysiology of anaphylactic shock is crucial for nurses caring for pediatric patients. Recognizing the signs and symptoms, including the decrease in systemic vascular resistance, can help nurses initiate prompt treatment such as administering epinephrine and maintaining airway patency. This knowledge is essential for providing safe and effective care to pediatric patients experiencing anaphylactic shock.

Correct Answer: D

Rationale: In the context of pediatric acute lymphoblastic leukemia (ALL), the correct answer is D) Male sex. This is because male sex is associated with a worse prognosis in ALL. Studies have shown that male children with ALL tend to have a higher risk of relapse and poorer outcomes compared to female children. This may be due to biological differences or other factors not yet fully understood. Option A) Leukocytes 2000 /mm³ is not a bad prognostic criterion in ALL. In fact, a lower leukocyte count at diagnosis is generally associated with a more favorable prognosis. Option B) Age 5 years is not inherently a bad prognostic criterion. While age can play a role in prognosis, being 5 years old alone does not make it a bad prognostic factor. Option C) White race is not a bad prognostic criterion in ALL. Race should not be a determining factor in predicting prognosis in pediatric leukemia. Educationally, understanding prognostic factors in pediatric ALL is crucial for nurses and healthcare providers caring for these patients. Recognizing these factors can help guide treatment decisions, monitor for potential complications, and provide appropriate support to patients and families. It is important to stay updated on the latest research and guidelines to ensure the best possible outcomes for children with ALL.

Correct Answer: A

Rationale: In the treatment of metabolic acidosis, the expected change in serum potassium level is that it will drop. This is because in metabolic acidosis, there is an excess of hydrogen ions in the body, leading to an intracellular shift of potassium ions in exchange for hydrogen ions. As the acidosis is corrected, the excess hydrogen ions are eliminated, causing potassium ions to shift back into the cells, resulting in a decrease in serum potassium levels. Option B, stating that serum potassium will initially drop then rise, is incorrect because the primary correction of metabolic acidosis involves the movement of potassium back into the cells, leading to a decrease in serum levels overall. Option C, suggesting that serum potassium will initially rise then drop, is inaccurate as the correction of metabolic acidosis does not typically lead to an initial increase in serum potassium levels. Instead, the correction process involves the movement of potassium back into the cells, causing serum levels to decrease. Option D, stating that serum potassium will remain the same, is also incorrect because the correction of metabolic acidosis involves an exchange of ions that will lead to a decrease in serum potassium levels as acidosis is treated. Understanding the expected changes in serum electrolyte levels during metabolic disturbances is crucial for nurses and healthcare providers caring for pediatric patients. It helps in assessing and managing the patient's condition effectively, preventing potential complications related to electrolyte imbalances. Remembering the relationship between acid-base balance and electrolytes is essential in providing safe and competent care to pediatric patients.