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Chapter 11: The Pediatric Patient in the Adult Critical Care Unit
MULTIPLE CHOICE
ANS: B
Fluids at 1500 ml/m2 per day can be used for children who weigh more than 10 kg.
ANS: C
The circulating blood volume in a neonate is 85 to 90 ml/kg.
ANS: C
The dose of adenosine in a child with stable supraventricular tachycardia is 0.1 mg/kg
rapid IV push and may be increased by 0.05 mg/kg increments every 2 minutes to a
maximum of 0.25 mg/kg up to 12 mg or until termination of supraventricular tachycardia.
ANS: C
The normal cerebral perfusion pressure values are unknown in children. Cerebral
perfusion pressure is believed to be in the range of 40 to 60 mm Hg, but this figure may
vary because perfusion is determined by blood flow and not blood pressure.
5. The upper airway of the infant is different from that of an adult in that the infant’s
a. epiglottis is located lower than an adult’s.
b. tongue is larger and it fills the oral cavity.
c. larynx is tubular shaped with its narrowest portion at the epiglottis.
d. airway is more rigid than an adult's.
ANS: B
The upper airway of the infant is different from that of an adult in that the infant’s tongue
is larger and it fills the oral cavity.
6. To establish a patent airway in an infant or child younger than 2 years, the nurse
would
a. perform the head tilt/chin lift maneuver.
b. hyperextend the neck and pull the jaw forward.
c. place a towel under the upper shoulders with the jaw slightly extended into
“sniffing” position.
ANS: C
To establish a patent airway in an infant or child younger than 2 years, a towel should be
placed under the upper shoulders with the jaw slightly extended into “sniffing” position.
7. Which of the following methods can be used to establish an endotracheal tube size for
a child younger than 2 years?
a. No formula exists; the endotracheal tube size is matched to the infant’s age.
b. Take the child’s age, add 16, and divide by 4.
c. Measure the length of the child’s little finger and divide by 2.
d. Only one size available; thus no method is needed.
ANS: A
For the child younger than 2 years, no formula exists for measuring endotracheal tube
size. Endotracheal tube size is matched to the child's age.
ANS: A
The pathophysiologic consequences of respiratory syncytial virus include inflammation
of the respiratory epithelium, resulting in submucosal edema.
9. C is a 5-year-old boy who has been admitted with severe asthma. His initial PaCO2
was 30. One hour later his PaCO2 is 45, and 1 hour after that his PaCO2 is 56. Which
of the following interventions would be anticipated?
a. High-dose steroids
ANS: D
Criteria for mechanical ventilation include a PaCO2 more than 55 mm Hg or increasing
greater than 5 to 10 mm Hg/hr.
ANS: C
The pathophysiologic characteristic of a left-to-right shunt is increased pulmonary blood
flow.
ANS: B
Cyanosis that increases with crying is thought to be cardiac in origin. Cyanosis that
decreases with crying is thought to be respiratory in origin.
12. The most common cardiac arrest–related dysrhythmia in the pediatric patient is
a. supraventricular tachycardia.
b. ventricular tachycardia.
c. bradycardia.
d. first-degree heart block.
ANS: C
The most common dysrhythmia in the pediatric patient is bradycardia resulting from
hypoxia, acidosis, or hypothermia.
ANS: C
The initial setting for defibrillation of a child is 2 joules/kg.
K is a 4-year-old girl admitted to the critical care unit with fever, chills, headache,
vomiting, lethargy, photophobia, and nuchal rigidity.
ANS: B
Fever, chills, headache, vomiting, lethargy, photophobia, and nuchal rigidity are clinical
manifestations of meningitis
ANS: C
The child with meningitis is isolated during initial antibiotic treatment and for 24 hours
thereafter.
16. K has been unable to eat, and tube feedings are to be initiated. The preferred method
for determining the insertion length of the nasogastric tube is to measure from the
a. nares to the ears to the xiphoid process.
b. ears to the umbilicus.
c. nares to the xiphoid to the ears.
d. nares to the ears to a point between the xiphoid process and the umbilicus.
ANS: D
The preferred method for determining the insertion length of the nasogastric tube is to
measure from nares to the ears to a point between the xiphoid process and the umbilicus.
COMPLETION
ANS:
Apnea, bradycardia
Bradycardia, apnea
Rationale: Unlike adults, most cardiac arrests in the pediatric population are related to
respiratory failure.
PROBLEM
1. By using the “rule of 6,” calculate the amount of dopamine needed to add to the
intravenous fluid for an 18-kg infant.
ANS:
108 mg
Rationale: Dopamine is dosed in micrograms per kilogram per minute. The “rule of 6”
formula is to multiply the patient’s weight in kilograms by 6 and add that amount to 100
ml of fluid.
2. Calculate the estimated daily fluid needs for an infant weighing 10 kg and receiving
mechanical ventilation.
ANS:
880 ml/day
Rationale: A health 10-kg infant requires approximately 100 ml/kg per day of fluid.
However, when receiving humidified mechanical ventilation, this amount should be
reduced by 12%.
OTHER
1. Which of the following anatomic and physiologic findings are normal in the infant?
Select all that apply.
a. The epiglottis is large and floppy.
b. The basal metabolic rate is lower than that of an adult.
c. The size of the head is smaller compared with the rest of the body.
d. The hormonal and metabolic response to pain is the same as that of an adult.
e. A positive Babinski response is a normal finding.
ANS:
a, d, e
Rationale: Many anatomic and physiologic differences exist between the adult and the
infant.
2. Optimal treatment of the pediatric patient with asthma includes which of the
following? Select all that apply.
a. Placing the patient in the knee-chest position
b. Extending the neck to promote opening of the airway
c. Reducing exposure to allergens
d. Patient education
e. Alleviating anxiety
ANS:
c, d, e
Rationale: The goals of treatment for the pediatric patient with asthma are controlling the
environment, managing pharmacologic therapy, and providing patient education in
preventing exacerbations.