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: The correct answer is B) 10. In a Glasgow Coma Scale (GCS) assessment, the maximum score is 15, with higher scores indicating a higher level of consciousness. The GCS is based on eye opening, verbal response, and motor response. In this case, the child opens their eyes to a painful stimulus, indicating a GCS eye score of 2. They are confused, suggesting a verbal response score of 4, and withdraws from pain, indicating a motor response score of 4, totaling a GCS score of 10. Option A) 8 is incorrect because with an eye score of 2, verbal score of 2 (confusion), and motor score of 4 (withdrawal), the total GCS score should be 8, not 10. Option C) 11 is incorrect as the verbal response of confusion would only score 4, not 5, and withdrawal from pain scores 4, not 5, resulting in a total GCS score of 10, not 11. Option D) 13 is incorrect because the child's responses do not indicate a high level of consciousness as reflected in a GCS score of 13. The verbal and motor responses given by the child do not align with a score of 5 on each component, making a total score of 13 inaccurate. Understanding the GCS is crucial in assessing pediatric patients with head injuries as it helps to determine the severity of the injury and monitor changes in their level of consciousness. This educational context highlights the importance of accurately interpreting and applying the GCS in clinical practice to guide appropriate interventions and monitoring in pediatric patients with head trauma.

Correct Answer: B

Rationale: In the context of pediatric nursing, understanding the signs of circulatory failure is crucial for providing timely and effective care to children. In this question, option B, "Marked tachypnea with recessions," is the correct answer as it is a sign that is actually in favor of circulatory failure. Tachypnea (rapid breathing) with retractions (visible sinking of the skin between and around the ribs) indicates increased work of breathing, which can be a response to decreased cardiac output in circulatory failure. Option A, "Cyanosis despite supplied O2," is incorrect because cyanosis despite oxygen supplementation can be a sign of respiratory distress rather than circulatory failure. It indicates that the child is not effectively oxygenating despite receiving supplemental oxygen. Option C, "Gallop rhythm/murmur," is incorrect as it is a sign that can be present in circulatory failure. A gallop rhythm or murmur may indicate underlying cardiac issues contributing to circulatory compromise. Option D, "Enlarged tender liver," is incorrect as it can be a sign of hepatic (liver) involvement in circulatory failure, such as congestive heart failure. An enlarged and tender liver can result from congestion and backup of blood flow due to circulatory issues. Educationally, this question highlights the importance of recognizing subtle signs of circulatory failure in pediatric patients. It emphasizes the need for nurses to be able to differentiate between respiratory and circulatory symptoms, as well as understand the interconnectedness of cardiac and respiratory systems in pediatric patients. By grasping these concepts, nurses can provide prompt and appropriate interventions to optimize outcomes for children experiencing circulatory compromise.

Correct Answer: B

Rationale: Anaphylactic shock is a severe, life-threatening allergic reaction. The correct answer, option B, "Decreased systemic vascular resistance," is characteristic of anaphylactic shock. During anaphylaxis, there is a widespread release of histamine and other mediators, causing vasodilation and increased capillary permeability, leading to decreased systemic vascular resistance. This results in a drop in blood pressure and impaired tissue perfusion. Option A, "Airway obstruction," can occur in anaphylactic shock due to swelling of the airways, but it is not the defining characteristic. Option C, "Generalized vasoconstriction," is incorrect as anaphylactic shock is characterized by vasodilation, not vasoconstriction. Option D, "Hypovolemia," is not the primary issue in anaphylactic shock; while fluid shifts can occur, the main concern is the systemic vasodilation leading to shock. In an educational context, understanding the pathophysiology of anaphylactic shock is crucial for nurses caring for pediatric patients. Recognizing the signs and symptoms early, such as decreased systemic vascular resistance leading to shock, can prompt quick intervention with epinephrine and other treatments to stabilize the child's condition. Nurses must be prepared to assess, intervene, and monitor pediatric patients experiencing anaphylactic shock to ensure positive outcomes.

Correct Answer: D

Rationale: In the context of pediatric acute lymphoblastic leukemia (ALL), the correct answer is D) Male sex being a bad prognostic criterion. Male sex is associated with a poorer prognosis in pediatric ALL due to biological differences in how the disease presents and responds to treatment between males and females. Males tend to have a higher risk of relapse and poorer outcomes compared to females. Option A) Leukocytes 2000 /mm³ is not a bad prognostic criterion, as a lower leukocyte count is generally considered a favorable prognostic factor in pediatric ALL. Option B) Age 5 years is not a bad prognostic criterion either, as younger age at diagnosis is typically associated with a better prognosis in pediatric ALL. Option C) White race is not a bad prognostic criterion in pediatric ALL. Race does not inherently impact prognosis in ALL; rather, factors such as genetics and access to healthcare may play a role. In an educational context, understanding prognostic factors in pediatric ALL is crucial for healthcare providers caring for children with this condition. Recognizing these factors helps guide treatment decisions and allows for better prognostication and management of the disease. By knowing which factors are associated with poorer outcomes, healthcare providers can tailor treatment plans to optimize patient outcomes.

Correct Answer: A

Rationale: In the context of treating metabolic acidosis, the expected change in serum potassium level is a key concept that nurses and healthcare providers must understand. Correct answer (A): It will drop - In metabolic acidosis, there is an excess of acid in the body leading to a shift of potassium from the intracellular to extracellular space. As treatment corrects the acid-base imbalance, potassium is taken back into the cells, causing a decrease in serum potassium levels. Option B: It will initially drop then rise - This option is incorrect because the primary effect of treating metabolic acidosis is the reduction of serum potassium levels due to the movement of potassium back into the cells. There is no subsequent rise in potassium levels expected during treatment. Option C: It will initially rise then drop - This option is incorrect as metabolic acidosis would not cause serum potassium levels to rise. The correction of acidosis leads to a decrease in serum potassium levels as potassium re-enters the cells. Option D: It will remain the same - This option is inaccurate because in the context of treating metabolic acidosis, the serum potassium level is expected to decrease as acidosis is corrected and potassium shifts intracellularly. Educational context: Understanding the relationship between acid-base balance and electrolyte levels is crucial in pediatric nursing practice. Nurses need to be able to anticipate changes in electrolyte levels during the treatment of acid-base imbalances to provide safe and effective care to pediatric patients. By comprehending the expected changes in serum potassium levels during metabolic acidosis treatment, nurses can monitor patients for potential electrolyte disturbances and intervene promptly if needed.