In pediatric shock, which of the following is an early sign?

Correct Answer: D

Rationale: In pediatric shock, tachycardia is considered an early sign because it is the body's initial compensatory mechanism to maintain perfusion to vital organs in response to decreased blood volume or circulation. Tachycardia helps maintain cardiac output and blood pressure in the early stages of shock by increasing heart rate. Hypotension (Option A) is a late sign in pediatric shock and indicates significant cardiovascular compromise. It occurs after compensatory mechanisms like tachycardia have been overwhelmed and the body is unable to maintain adequate perfusion. Disturbed consciousness level (Option B) typically occurs later in the progression of shock as the brain is deprived of oxygen due to poor perfusion. Cheyne-Stokes breathing (Option C) is an abnormal pattern of breathing characterized by alternating periods of deep and shallow breathing. While it can occur in shock, it is not typically an early sign and is more indicative of severe or prolonged hypoxia. Educationally, understanding the early signs of pediatric shock is crucial for nurses caring for pediatric patients. Recognizing tachycardia as an early sign can prompt timely intervention and potentially prevent progression to more severe stages of shock, improving patient outcomes. Nurses should be vigilant in monitoring for subtle changes in vital signs and clinical presentation to identify shock early and initiate appropriate treatment.

Correct Answer: D

Rationale: In pediatric nursing, understanding raised intracranial pressure (ICP) is crucial as it can indicate serious neurological issues. The correct definition of raised ICP in children is when it exceeds 20 mmHg for more than five minutes (Option D). This level of ICP can lead to decreased cerebral perfusion, causing brain damage. Option A (Increased ICP more than 8 mmHg for more than one day) is incorrect as an ICP of 8 mmHg is within the normal range and one day is too long for a significant increase to occur. Option B (Increased ICP more than 6 mmHg for more than one hour) is also incorrect because an ICP of 6 mmHg is normal, and one hour is not enough time for a concerning increase. Option C (Increased ICP more than 10 mmHg for more than one minute) is incorrect as 10 mmHg is still within normal limits, and one minute is too short a time frame to assess for raised ICP accurately. Educationally, it is essential for pediatric nurses to be able to recognize the signs and symptoms of raised ICP promptly, as early intervention is crucial in preventing further complications. Monitoring ICP levels and understanding the thresholds for intervention are vital skills in pediatric critical care settings. Option D represents a critical level of raised ICP that requires immediate attention to prevent neurological damage, making it the correct answer in this scenario.

Correct Answer: B

Rationale: The correct answer is B) Expelling a foreign body in the airway in the unconscious child. The Heimlich maneuver is a first aid procedure used to help a choking person who is conscious or unconscious by dislodging an obstruction in their airway. In a pediatric setting, this maneuver is crucial as children are more prone to choking due to their exploratory behavior and small airways. Option A is incorrect because the Heimlich maneuver is not used to assess if a child is breathing or not; it is specifically used for airway obstruction. Option C is incorrect as chest compressions in a large child are part of CPR but not the Heimlich maneuver, which focuses on abdominal thrusts to expel the obstruction. Option D is incorrect because the Heimlich maneuver is not used to open the airway in the presence of a possible cervical spine injury; in such cases, manual stabilization of the head and neck would be necessary. In an educational context, understanding and being able to correctly perform the Heimlich maneuver is a critical skill for healthcare providers, particularly those working with pediatric populations. It can be life-saving in situations where a child is choking and unable to breathe. Proper training and practice in this maneuver can help prevent serious complications and even save lives in emergency situations involving pediatric patients.

Correct Answer: B

Rationale: In the treatment of hypernatremia, the maximum accepted rate of drop of serum sodium per 24 hours is 12 mmol/L (Option B). This rate is considered safe to prevent rapid changes in serum sodium levels that can lead to complications such as cerebral edema. Option A (8 mmol/L) is too conservative and may not effectively correct hypernatremia in a timely manner, especially in severe cases where a faster reduction is needed to prevent adverse effects on the brain. Options C (16 mmol/L) and D (20 mmol/L) are too aggressive and can lead to overly rapid correction of serum sodium levels, potentially causing neurological damage such as central pontine myelinolysis. In pediatric nursing practice, it is crucial to carefully monitor and control the rate of correction of electrolyte imbalances to ensure patient safety. By understanding the appropriate rate of change in serum sodium levels, nurses can provide optimal care and prevent complications associated with hypernatremia treatment.

Correct Answer: A

Rationale: In pediatric nursing, understanding the physiological responses to serious illness is crucial for providing effective care to children. In this question, the correct answer is A) Blood pressure. Blood pressure typically decreases in response to serious illness in children. This is due to factors such as decreased cardiac output and peripheral vascular resistance. An increase in blood pressure would not be a typical physiological response to serious illness in pediatric patients. Option B) Heart rate often increases in response to serious illness as the body tries to compensate for the stress and maintain adequate perfusion. Option C) Respiratory rate may also increase as the body works harder to meet oxygen demands. Option D) Action of accessory respiratory muscles may be seen in children with respiratory distress, indicating increased effort to breathe. Educationally, understanding these physiological responses helps nurses assess and manage critically ill pediatric patients. Recognizing abnormal vital signs can prompt timely interventions and prevent deterioration. It is important for pediatric nurses to be knowledgeable about normal and abnormal responses to illness to provide optimal care and support to children in need.