Editing Pediatric Nursing – RN Practice Questions (section)

==Question 4==
The nurse on a pediatric unit receives report on four children. Which child should the nurse assess '''first'''?
# A 6-month-old with bronchiolitis whose respiratory rate has decreased from 66 to 28 breaths per minute and who is now difficult to arouse
# A 4-year-old with asthma who is wheezing audibly and using accessory muscles after a nebulizer treatment
# A 10-year-old in sickle cell vaso-occlusive crisis who rates leg pain 8 out of 10 and is due for morphine
# A 2-year-old with gastroenteritis who has had one episode of emesis in the last hour and dry mucous membranes

'''Answer:''' 1. The 6-month-old with bronchiolitis whose respiratory rate has fallen and who is difficult to arouse.

''Rationale:'' A falling respiratory rate combined with decreasing responsiveness in a previously tachypneic infant signals exhaustion and impending respiratory failure and arrest, not improvement. This is the classic pediatric deterioration pattern and takes priority. The child in option 2 is in distress but is still moving air and ventilating audibly, which is less ominous than a quiet, obtunded infant. Options 3 and 4 are urgent but stable problems that follow.