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ACCNS-P practice questions

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Question 1Pediatric Clinical Nurse Specialist - Clinical Judgment

A 6-year-old is brought to the emergency department with drooling, tripod positioning, and muffled voice after a sudden onset of fever and sore throat. Which initial action is most appropriate?

  1. Place the child supine and start a nebulized epinephrine treatment
  2. Obtain a throat swab for rapid strep testing
  3. Inspect the throat with a tongue blade to visualize the tonsils
  4. Keep the child calm and upright and notify the airway team Correct answer.

Explanation

Drooling, tripod positioning, and a muffled voice suggest epiglottitis with risk of sudden airway obstruction. The priority is to avoid agitating the child or instrumenting the airway, keeping the child upright and calm while mobilizing airway expertise. Any maneuver that provokes crying or gagging can precipitate complete obstruction.

Question 2Pediatric Clinical Nurse Specialist - Clinical Judgment

Which finding is most characteristic of respiratory distress in an infant?

  1. Sunken fontanelle with dry mucous membranes
  2. Bradycardia with hypertension
  3. Hyperactive bowel sounds
  4. Nasal flaring with intercostal retractions Correct answer.

Explanation

Nasal flaring and intercostal retractions are classic signs of increased work of breathing in infants because of their compliant chest wall and reliance on accessory muscles. The other findings reflect dehydration or other systems, not respiratory distress.

Question 3Pediatric Clinical Nurse Specialist - Clinical Judgment

A 4-year-old with a ventricular septal defect has a loud holosystolic murmur and is growing poorly. Which pathophysiologic mechanism best explains the poor growth?

  1. Obstruction of systemic blood flow by a narrowed aortic valve
  2. Left-to-right shunting causing pulmonary overcirculation and increased cardiac work Correct answer.
  3. Right-to-left shunting causing chronic hypoxemia
  4. Inadequate atrial filling from pericardial effusion

Explanation

A ventricular septal defect produces a left-to-right shunt, so extra blood recirculates through the pulmonary circulation. This increases cardiac workload and pulmonary blood flow, raising metabolic demand and causing poor weight gain.

Question 4Pediatric Clinical Nurse Specialist - Clinical Judgment

A child with sickle cell disease presents with fever of 39°C and appears ill. What is the priority nursing action?

  1. Administer antipyretics and reassess in 4 hours
  2. Encourage oral fluids and apply cool compresses
  3. Obtain blood cultures and give antibiotics promptly Correct answer.
  4. Schedule an outpatient follow-up visit for tomorrow

Explanation

Children with sickle cell disease are functionally asplenic and at high risk for overwhelming sepsis, so fever is a medical emergency. Blood cultures should be drawn and empiric antibiotics given promptly, ideally within an hour.

Question 5Pediatric Clinical Nurse Specialist - Clinical Judgment

Which assessment finding best indicates adequate hydration in a 2-year-old with gastroenteritis?

  1. Urine output of 1 to 2 mL/kg/hour Correct answer.
  2. Heart rate of 150 beats per minute
  3. Capillary refill of 4 seconds
  4. Dry mucous membranes

Explanation

A urine output of at least 1 mL/kg/hour reflects adequate renal perfusion and hydration. Prolonged capillary refill, tachycardia, and dry mucous membranes are signs of dehydration.

Question 6Pediatric Clinical Nurse Specialist - Clinical Judgment

A 10-year-old with new-onset type 1 diabetes presents with Kussmaul respirations, fruity breath, and blood glucose of 480 mg/dL. Which order should the nurse question?

  1. Monitor serum potassium closely during treatment
  2. Begin an intravenous isotonic fluid bolus
  3. Start an insulin infusion per protocol
  4. Administer subcutaneous insulin now and discharge home Correct answer.

Explanation

Kussmaul respirations and fruity breath indicate diabetic ketoacidosis, a medical emergency requiring intravenous fluids, insulin infusion, and electrolyte monitoring. Subcutaneous insulin with discharge home is unsafe because DKA requires inpatient management and potassium can fall dangerously during treatment.

Question 7Pediatric Clinical Nurse Specialist - Clinical Judgment

An infant is noted to have a bulging anterior fontanelle, sunsetting eyes, and increasing head circumference. Which condition should the nurse suspect?

  1. Hydrocephalus Correct answer.
  2. Otitis media
  3. Cerebral palsy
  4. Febrile seizure

Explanation

A bulging fontanelle, sunsetting eyes, and rapidly increasing head circumference are hallmark signs of hydrocephalus from increased intracranial pressure and ventricular enlargement. These findings warrant urgent neurosurgical evaluation.

Question 8Pediatric Clinical Nurse Specialist - Clinical Judgment

Which intervention is most important immediately after a lumbar puncture in a child?

  1. Restrict all oral fluids for 12 hours
  2. Ambulate the child immediately to prevent stiffness
  3. Place the child in Trendelenburg position for 2 hours
  4. Keep the child flat for a period per protocol and encourage hydration Correct answer.

Explanation

Lying flat after a lumbar puncture and maintaining hydration reduce the risk of post-dural puncture headache from cerebrospinal fluid leakage. Early ambulation increases the likelihood of headache.

Question 9Pediatric Clinical Nurse Specialist - Clinical Judgment

A 3-year-old with a new diagnosis of acute lymphoblastic leukemia is started on induction chemotherapy. Which laboratory value requires the most immediate intervention?

  1. Absolute neutrophil count 1,200/mm³
  2. Platelet count 8,000/mm³ Correct answer.
  3. Potassium 4.0 mEq/L
  4. Hemoglobin 9.5 g/dL

Explanation

A platelet count of 8,000/mm³ places the child at high risk for spontaneous hemorrhage, including intracranial bleeding, and requires prompt platelet transfusion. The other values are not immediately life-threatening.

Question 10Pediatric Clinical Nurse Specialist - Clinical Judgment

Which immunization is contraindicated in a child with severe combined immunodeficiency?

  1. Inactivated influenza vaccine
  2. Live attenuated measles-mumps-rubella vaccine Correct answer.
  3. Hepatitis B vaccine
  4. Diphtheria-tetanus-acellular pertussis vaccine

Explanation

Live attenuated vaccines are contraindicated in children with severe immunodeficiency because the weakened organism can cause disseminated disease. Inactivated vaccines are generally safe.

Question 11Pediatric Clinical Nurse Specialist - Clinical Judgment

A 12-year-old with asthma has a peak expiratory flow at 55% of personal best and is speaking in short phrases. Which classification best describes this exacerbation?

  1. Severe exacerbation Correct answer.
  2. Mild intermittent
  3. Moderate persistent
  4. Well controlled

Explanation

A peak flow of 40% to 69% of personal best with speaking in short phrases indicates a severe asthma exacerbation requiring urgent bronchodilator therapy and close monitoring. Mild exacerbations typically have peak flow above 70% with full sentences.

Question 12Pediatric Clinical Nurse Specialist - Clinical Judgment

A child with nephrotic syndrome has periorbital edema, a serum albumin of 1.8 g/dL, and 4+ proteinuria. Which nursing intervention is most important?

  1. Restrict all visitors to prevent infection
  2. Encourage a high-sodium diet to improve appetite
  3. Limit fluid intake to 200 mL per day
  4. Monitor daily weight and abdominal girth Correct answer.

Explanation

Daily weights and abdominal girth monitoring track fluid shifts and edema in nephrotic syndrome. Sodium should be restricted, not increased, and fluid restriction is individualized rather than fixed at an arbitrary low volume.

Question 13Pediatric Clinical Nurse Specialist - Clinical Judgment

Which finding in a 5-year-old with acute glomerulonephritis requires immediate reporting?

  1. Dark cola-colored urine
  2. Blood pressure 138/92 mm Hg with headache Correct answer.
  3. Periorbital edema in the morning
  4. Urine output of 500 mL in 24 hours

Explanation

Hypertension with headache in acute glomerulonephritis may signal hypertensive encephalopathy or seizures and requires immediate intervention. Cola-colored urine and periorbital edema are expected findings, and 500 mL of urine in 24 hours is generally adequate for this age.

Question 14Pediatric Clinical Nurse Specialist - Clinical Judgment

A 2-year-old presents with a barking cough, inspiratory stridor, and hoarseness that worsens at night. Which condition is most likely?

  1. Bronchiolitis
  2. Foreign body aspiration
  3. Epiglottitis
  4. Croup Correct answer.

Explanation

A barking cough with inspiratory stridor and hoarseness in a toddler is characteristic of croup, a viral laryngotracheitis. Symptoms typically worsen at night and improve with cool mist or dexamethasone.

Question 15Pediatric Clinical Nurse Specialist - Clinical Judgment

An adolescent with anorexia nervosa has a heart rate of 42 beats per minute and a potassium of 2.9 mEq/L. Which action is most appropriate?

  1. Allow outpatient monitoring with weekly weigh-ins
  2. Initiate continuous cardiac monitoring and notify the provider Correct answer.
  3. Encourage a high-calorie meal and reassess in 24 hours
  4. Restrict activity and recheck electrolytes in one week

Explanation

Bradycardia and hypokalemia in anorexia nervosa increase the risk of life-threatening arrhythmias and require continuous cardiac monitoring and provider notification. Outpatient management is unsafe with these findings.

Question 16Pediatric Clinical Nurse Specialist - Clinical Judgment

Which is the earliest sign of increased intracranial pressure in a school-age child?

  1. Decerebrate posturing
  2. Loss of brainstem reflexes
  3. Change in level of consciousness Correct answer.
  4. Fixed dilated pupils

Explanation

A change in level of consciousness is typically the earliest indicator of rising intracranial pressure. Pupillary changes, posturing, and loss of brainstem reflexes are later, more ominous findings.

Question 17Pediatric Clinical Nurse Specialist - Clinical Judgment

A 7-year-old is admitted with burns over 25% of total body surface area. Which fluid resuscitation principle guides initial management?

  1. Restrict fluids until urine output falls
  2. Replace estimated losses using a weight- and burn-based formula Correct answer.
  3. Give only maintenance fluids for the first 24 hours
  4. Use hypertonic saline as the primary resuscitative fluid

Explanation

Significant burns cause massive capillary leak and require fluid resuscitation calculated by a weight- and burn-size-based formula, typically using lactated Ringer's. Adequate urine output guides titration.

Question 18Pediatric Clinical Nurse Specialist - Clinical Judgment

A neonate born at 39 weeks has a respiratory rate of 90, grunting, and nasal flaring within the first hours of life. Which condition should the nurse prioritize?

  1. Congenital diaphragmatic hernia
  2. Transient tachypnea of the newborn Correct answer.
  3. Meconium aspiration syndrome
  4. Physiologic anemia

Explanation

Transient tachypnea of the newborn commonly presents in term or late-preterm infants shortly after birth with tachypnea, grunting, and flaring due to retained fetal lung fluid. It usually resolves within 24 to 72 hours with supportive care.

Question 19Pediatric Clinical Nurse Specialist - Clinical Judgment

Which statement about pediatric pain assessment is most accurate?

  1. Behavioral scales should be used for adolescents instead of self-report
  2. Self-report is the preferred standard when the child is developmentally able Correct answer.
  3. Vital signs alone reliably quantify pain intensity
  4. The numeric rating scale is appropriate for all ages

Explanation

Self-report is the preferred standard for pain assessment whenever the child can understand and use an appropriate tool. Behavioral and physiologic measures are used when self-report is not possible.

Question 20Pediatric Clinical Nurse Specialist - Clinical Judgment

An infant with tetralogy of Fallot becomes cyanotic and irritable after crying. Which action should the nurse take first?

  1. Administer oral digoxin
  2. Obtain a chest radiograph
  3. Place the infant in knee-chest position Correct answer.
  4. Apply supplemental oxygen via blow-by

Explanation

Crying increases right-to-left shunting in tetralogy of Fallot, causing a hypercyanotic spell. The knee-chest position increases systemic vascular resistance and reduces the shunt, making it the first-line intervention.

Question 21Pediatric Clinical Nurse Specialist - Clinical Judgment

A child is receiving intravenous vancomycin. Which assessment finding requires immediate action?

  1. Mild nausea after the dose
  2. Infusion site that is warm and dry
  3. Facial flushing and hypotension during the infusion Correct answer.
  4. Complaint of a metallic taste

Explanation

Facial flushing and hypotension during vancomycin infusion indicate vancomycin infusion reaction (formerly red man syndrome), which requires stopping or slowing the infusion and notifying the provider. Antihistamines may be given for severe reactions.

Question 22Pediatric Clinical Nurse Specialist - Clinical Judgment

Which finding is a hallmark of pyloric stenosis in a 5-week-old infant?

  1. Bloody diarrhea with lethargy
  2. Projectile nonbilious vomiting after feeding Correct answer.
  3. Abdominal distention with absent bowel sounds
  4. Bilious vomiting immediately at birth

Explanation

Hypertrophic pyloric stenosis causes progressive projectile nonbilious vomiting in the first weeks of life as the pylorus narrows. Bilious vomiting suggests obstruction distal to the ampulla of Vater.

Question 23Pediatric Clinical Nurse Specialist - Clinical Judgment

A child with a ventriculoperitoneal shunt presents with vomiting, headache, and lethargy. Which action is most appropriate?

  1. Apply pressure over the shunt valve
  2. Obtain a shunt series and neurosurgical consultation emergently Correct answer.
  3. Discharge with instructions to return if symptoms worsen
  4. Place the child flat and give an antiemetic

Explanation

Vomiting, headache, and lethargy in a child with a shunt suggest shunt malfunction with increased intracranial pressure. Emergent imaging and neurosurgical consultation are required to evaluate and revise the shunt.

Question 24Pediatric Clinical Nurse Specialist - Clinical Judgment

A 9-year-old with Duchenne muscular dystrophy has a vital capacity of 40% predicted. Which intervention should the nurse anticipate?

  1. Discontinue routine immunizations
  2. Initiate noninvasive ventilation support Correct answer.
  3. Restrict all activity to bed rest
  4. Encourage vigorous aerobic exercise

Explanation

Declining vital capacity in Duchenne muscular dystrophy signals respiratory muscle weakness, and noninvasive ventilation support is indicated when vital capacity falls below about 50% predicted. Immunizations should be kept current to prevent respiratory infection.

Question 25Pediatric Clinical Nurse Specialist - Clinical Judgment

Which finding suggests child physical abuse rather than accidental injury?

  1. A single forehead abrasion after a fall
  2. Injury inconsistent with the developmental stage and history Correct answer.
  3. Bruising over a bony prominence
  4. Bruises on the shins of a toddler who is learning to walk

Explanation

An injury that does not match the child's developmental abilities or the reported mechanism raises concern for abuse. Bruising over bony prominences and shin bruises in ambulatory toddlers are typical accidental findings.

Question 26Pediatric Clinical Nurse Specialist - Clinical Judgment

A 4-year-old is brought to the emergency department with a 3-day history of vomiting and diarrhea. Which assessment finding best indicates that the child has moderate rather than mild dehydration?

  1. Capillary refill of 4 seconds with sunken eyes Correct answer.
  2. Slightly dry lips with a normal heart rate
  3. Weight loss of 2% since the last visit
  4. Moist mucous membranes with normal skin turgor

Explanation

Moderate dehydration is characterized by delayed capillary refill, sunken eyes, and decreased skin turgor, reflecting intravascular volume loss. Mild dehydration shows only subtle findings such as dry lips and minimal weight loss.

Question 27Pediatric Clinical Nurse Specialist - Clinical Judgment

Which vital sign is the most sensitive early indicator of respiratory compromise in a young child?

  1. Oxygen saturation by pulse oximetry
  2. Temperature
  3. Respiratory rate Correct answer.
  4. Blood pressure

Explanation

Tachypnea is typically the earliest compensatory response to respiratory distress in children, appearing before oxygen desaturation or blood pressure changes. Pulse oximetry may remain normal until the child tires and decompensates.

Question 28Pediatric Clinical Nurse Specialist - Clinical Judgment

A school-age child is prescribed oral amoxicillin for otitis media. Which instruction should the nurse include to best promote adherence and effectiveness?

  1. Administer with milk to improve absorption
  2. Stop the medication once the ear pain resolves
  3. Give the full course even after symptoms resolve Correct answer.
  4. Give the dose only when the child has a fever

Explanation

Antibiotics must be completed as prescribed to eradicate the infection and reduce the risk of resistance and relapse. Stopping early when symptoms improve can allow residual organisms to survive.

Question 29Pediatric Clinical Nurse Specialist - Clinical Judgment

Which developmental milestone should a nurse expect a typically developing 9-month-old infant to demonstrate?

  1. Saying two-word phrases
  2. Using a pincer grasp
  3. Sitting without support Correct answer.
  4. Pulling to a standing position

Explanation

Independent sitting is typically achieved between 6 and 8 months, so a 9-month-old should sit without support. Pulling to stand and a pincer grasp emerge later, generally around 9 to 12 months.

Question 30Pediatric Clinical Nurse Specialist - Clinical Judgment

A toddler is admitted with a suspected foreign body aspiration and is coughing forcefully with audible wheezing. Which action should the nurse take?

  1. Give a dose of oral corticosteroid
  2. Place the child in a supine position
  3. Encourage the child to continue coughing Correct answer.
  4. Perform abdominal thrusts immediately

Explanation

When a child with a foreign body is coughing effectively and moving air, the recommendation is to encourage coughing and monitor closely rather than intervene. Interventions such as thrusts are reserved for ineffective cough or complete obstruction.

Question 31Pediatric Clinical Nurse Specialist - Clinical Judgment

Which laboratory finding is most consistent with iron deficiency anemia in a young child?

  1. Normal red cell distribution width
  2. Low serum ferritin Correct answer.
  3. Elevated reticulocyte count
  4. Elevated mean corpuscular volume

Explanation

Iron deficiency anemia produces low serum ferritin because iron stores are depleted before hemoglobin falls. The anemia is microcytic and hypochromic, and the red cell distribution width is typically elevated.

Question 32Pediatric Clinical Nurse Specialist - Clinical Judgment

A child is receiving an intravenous opioid for pain control. Which assessment is most important for the nurse to monitor?

  1. Deep tendon reflexes
  2. Respiratory rate and depth Correct answer.
  3. Blood glucose level
  4. Urine specific gravity

Explanation

Opioids depress the central respiratory drive, so respiratory rate and depth are the priority assessment to detect hypoventilation and prevent respiratory arrest. Other parameters are not the primary opioid-related risk.

Question 33Pediatric Clinical Nurse Specialist - Clinical Judgment

Which finding should the nurse report immediately in a child receiving chemotherapy who has a central venous catheter?

  1. Temperature of 38.3°C (101°F) Correct answer.
  2. A single episode of loose stool
  3. Complaint of mild fatigue
  4. Mild nausea after chemotherapy

Explanation

Fever in a neutropenic child receiving chemotherapy is a medical emergency because it may signal sepsis, and antibiotics should be started promptly. Nausea, a single loose stool, and fatigue are expected side effects that do not require immediate escalation.

Question 34Pediatric Clinical Nurse Specialist - Clinical Judgment

A child with sickle cell disease presents with a painful, swollen hand and fingers. Which complication should the nurse suspect?

  1. Septic arthritis of the wrist
  2. Osteomyelitis of the phalanges
  3. Dactylitis from vaso-occlusion Correct answer.
  4. Nerve compression syndrome

Explanation

Hand-foot syndrome, or dactylitis, results from vaso-occlusion in the small bones of the hands and feet and is often an early manifestation of sickle cell disease. It presents with symmetric swelling and pain.

Question 35Pediatric Clinical Nurse Specialist - Clinical Judgment

A 6-year-old is admitted with a new diagnosis of type 1 diabetes. Which teaching point about hypoglycemia should the nurse prioritize for the family?

  1. Give a high-fat snack as the first treatment
  2. Withhold all carbohydrate until the glucose normalizes
  3. Treat with 15 g of fast-acting carbohydrate and recheck in 15 minutes Correct answer.
  4. Administer the next insulin dose early

Explanation

The rule of 15 is the standard approach: give 15 g of fast-acting carbohydrate, recheck glucose in 15 minutes, and repeat if still low. High-fat foods slow absorption and are not the first-line treatment.

Question 36Pediatric Clinical Nurse Specialist - Clinical Judgment

A child with a seizure disorder is prescribed levetiracetam. Which parental report should prompt the nurse to notify the provider promptly?

  1. Complaint of a mild headache
  2. Mild drowsiness in the first week
  3. New-onset irritability and aggressive behavior Correct answer.
  4. A single missed dose

Explanation

Levetiracetam can cause behavioral adverse effects such as irritability, aggression, and mood changes, which warrant provider notification and possible dose adjustment. Drowsiness early in therapy and a single missed dose are common and less urgent.

Question 37Pediatric Clinical Nurse Specialist - Clinical Judgment

A 2-year-old is admitted with a suspected epiglottitis and is drooling with a muffled voice. Which action should the nurse take?

  1. Keep the child calm and upright with emergency airway support available Correct answer.
  2. Place the child supine for assessment
  3. Obtain a throat culture immediately
  4. Inspect the throat with a tongue blade

Explanation

In suspected epiglottitis, the priority is to avoid agitating the child and to maintain a position of comfort while preparing for emergency airway management. Inspecting the throat or obtaining cultures can precipitate complete airway obstruction.

Question 38Pediatric Clinical Nurse Specialist - Clinical Judgment

A child with heart failure is started on furosemide. Which laboratory value should the nurse monitor most closely?

  1. Serum phosphorus
  2. Serum calcium
  3. Serum potassium Correct answer.
  4. Serum magnesium

Explanation

Loop diuretics such as furosemide increase renal potassium excretion and can cause hypokalemia, which may provoke dysrhythmias. Potassium should be monitored closely and replaced as needed.

Question 39Pediatric Clinical Nurse Specialist - Clinical Judgment

A 10-year-old is admitted with acute post-streptococcal glomerulonephritis and has hypertension. Which nursing intervention is most appropriate?

  1. Increase fluid intake to promote diuresis
  2. Encourage vigorous ambulation
  3. Monitor blood pressure and restrict sodium intake Correct answer.
  4. Encourage a high-protein diet

Explanation

Managing hypertension in acute glomerulonephritis includes monitoring blood pressure frequently and restricting sodium and fluid intake. Activity restriction and fluid balance are also important until hematuria and hypertension resolve.

Question 40Pediatric Clinical Nurse Specialist - Clinical Judgment

A newborn is noted to have a sacral dimple with a tuft of hair and a small skin tag. Which action should the nurse take?

  1. Measure the dimple and reassess in one year
  2. Notify the provider for further evaluation of spinal dysraphism Correct answer.
  3. Document as a normal finding and discharge
  4. Apply a warm compress to the area

Explanation

A sacral dimple with a hair tuft or skin tag raises concern for occult spinal dysraphism and warrants provider notification and imaging. Simple dimples without these features are usually benign.

Question 41Pediatric Clinical Nurse Specialist - Clinical Judgment

A child with severe atopic dermatitis has extensive excoriations and honey-colored crusting. Which finding most suggests secondary bacterial infection?

  1. Lichenification of the flexures
  2. Generalized dry skin
  3. Honey-colored crusting with regional lymphadenopathy Correct answer.
  4. Petechiae on the trunk

Explanation

Honey-colored crusting with regional lymphadenopathy suggests secondary infection, commonly with Staphylococcus aureus, and warrants antibiotic treatment. Dry skin and lichenification reflect chronic atopic dermatitis rather than infection.

Question 42Pediatric Clinical Nurse Specialist - Clinical Judgment

A child has been receiving intravenous fluids at maintenance rate and now has periorbital edema, weight gain, and a serum sodium of 128 mEq/L. Which action should the nurse anticipate?

  1. Increasing the sodium content of the fluids
  2. Administering a bolus of free water
  3. Continuing the current rate unchanged
  4. Reducing or restricting the hypotonic fluid Correct answer.

Explanation

Hyponatremia with edema and weight gain in a child receiving hypotonic maintenance fluids suggests dilutional hyponatremia from excess free water. The appropriate action is to reduce or restrict the hypotonic fluid and reassess.

Question 43Pediatric Clinical Nurse Specialist - Clinical Judgment

A 15-year-old with type 1 diabetes has a blood glucose of 320 mg/dL, abdominal pain, and deep rapid breathing. Which action should the nurse take first?

  1. Administer a subcutaneous insulin correction dose
  2. Begin isotonic fluid resuscitation and prepare for an insulin infusion Correct answer.
  3. Give a dose of oral hypoglycemic agent
  4. Encourage oral fluids and reassess in one hour

Explanation

Diabetic ketoacidosis requires prompt isotonic fluid resuscitation followed by an intravenous insulin infusion, along with electrolyte monitoring. Subcutaneous insulin is inadequate in DKA because absorption is impaired by dehydration.

Question 44Pediatric Clinical Nurse Specialist - Clinical Judgment

A child with a known peanut allergy is brought in with hives, lip swelling, and wheezing after eating a cookie. Which medication should the nurse prepare to administer first?

  1. Intramuscular epinephrine Correct answer.
  2. Intravenous methylprednisolone
  3. Oral diphenhydramine
  4. Nebulized albuterol

Explanation

Intramuscular epinephrine is the first-line treatment for anaphylaxis because it rapidly reverses airway edema and vasodilation. Antihistamines and corticosteroids are adjuncts and do not treat airway compromise.

Question 45Pediatric Clinical Nurse Specialist - Clinical Judgment

A 7-year-old is admitted with a head injury and has a Glasgow Coma Scale score of 14 that drops to 11 over one hour. Which action should the nurse take?

  1. Administer a routine dose of acetaminophen
  2. Document the change and continue monitoring
  3. Notify the provider immediately and prepare for intervention Correct answer.
  4. Reassess in two hours

Explanation

A decline in the Glasgow Coma Scale score signals worsening neurologic status and possible rising intracranial pressure, requiring immediate provider notification. Early intervention can prevent secondary brain injury.

Question 46Pediatric Clinical Nurse Specialist - Clinical Judgment

A child with severe asthma has been receiving continuous albuterol and now reports increasing fatigue and has decreasing breath sounds with a rising carbon dioxide level. Which interpretation is most accurate?

  1. The child is experiencing an allergic reaction to albuterol
  2. The asthma is improving and therapy can be weaned
  3. The child has developed a pneumothorax
  4. The child is developing impending respiratory failure Correct answer.

Explanation

Increasing fatigue, diminishing breath sounds, and rising carbon dioxide indicate a failing respiratory effort and impending respiratory failure, requiring urgent escalation. A quiet chest in a previously wheezing child is an ominous sign.

Question 47Pediatric Clinical Nurse Specialist - Clinical Judgment

A child with a ventricular shunt is admitted with headache, vomiting, and lethargy. Which action should the nurse take while awaiting provider orders?

  1. Place the child flat and give a bolus of hypotonic fluid
  2. Position the child with the head elevated and monitor neurologic status Correct answer.
  3. Apply pressure to the shunt valve
  4. Perform a lumbar puncture

Explanation

These findings suggest shunt malfunction with increased intracranial pressure, so the head should be elevated and neurologic status monitored closely while the provider is notified. Lumbar puncture is contraindicated in suspected shunt failure with elevated pressure.

Question 48Pediatric Clinical Nurse Specialist - Clinical Judgment

A 3-year-old is admitted with a suspected brain tumor and has early-morning vomiting, a new head tilt, and ataxia. Which finding should the nurse report as most concerning for increased intracranial pressure?

  1. Early-morning vomiting
  2. Intermittent headache
  3. Mild irritability
  4. Head tilt and ataxia Correct answer.

Explanation

Head tilt and ataxia in a child with a suspected posterior fossa tumor suggest mass effect and increased intracranial pressure, and they require urgent reporting. Vomiting and headache are common but less specific signs.

Question 49Pediatric Clinical Nurse Specialist - Clinical Judgment

A 12-year-old with a new below-knee cast reports severe pain that is unrelieved by the prescribed opioid, and the toes are pale with decreased sensation. Which action should the nurse take?

  1. Apply a warm compress to the toes
  2. Elevate the leg above the heart and reassess in one hour
  3. Administer a second opioid dose
  4. Notify the provider immediately for possible compartment syndrome Correct answer.

Explanation

Pain out of proportion to the injury, pallor, and sensory changes are hallmarks of compartment syndrome, a surgical emergency requiring immediate provider notification and possible fasciotomy. Elevation above heart level can worsen perfusion.

Question 50Pediatric Clinical Nurse Specialist - Clinical Judgment

A 5-year-old with severe dehydration from gastroenteritis has received two boluses of isotonic fluid and remains lethargic with a capillary refill of 5 seconds. Which action should the nurse anticipate next?

  1. Continue oral rehydration alone
  2. Discontinue intravenous access
  3. Notify the provider for reassessment of shock and possible further resuscitation Correct answer.
  4. Give a hypotonic maintenance infusion only

Explanation

Persistent lethargy and delayed capillary refill after fluid boluses indicate ongoing shock and require provider reassessment and possibly further resuscitation. Oral rehydration alone is inadequate in a child with compromised perfusion.