A 3-year-old child is brought to the emergency department with ...

[lak]

A 3-year-old child is brought to the emergency department with sudden onset of hoarseness, wheezing, and cough. The child has a history of asthma, but the parent is worried about an aspirated toy part.
 
  Which action by the nurse would quickly differentiate between the two?
  A.
  Administer an inhaled bronchodilator.
  B.
  Auscultate lungs for unilateral wheezing.
  C.
  Obtain a stat portable chest x-ray.
  D.
  Quickly obtain an oxygen saturation.

Question 2

A 2-year-old child in a pediatric unit accidentally swallows a loose toy part and begins to exhibit signs of choking and wheezing. The pediatric nurse begins the Heimlich maneuver.
 
  After performing abdominal thrusts, what action does the nurse take next?
  A.
  Begin performing cardiopulmonary resuscitation (CPR).
  B.
  Activate the rapid response team then return to the child.
  C.
  Continue until the object is dislodged or the child becomes unconscious.
  D.
  Give five back blows, then alternate back blows and abdominal thrusts.

[gcook]

Answer to Question 1

ANS: B
In foreign body aspiration (FBA), wheezing would more likely be heard unilaterally. In an asthma exacerbation, wheezing would be bilateral. The other measures are appropriate care measures in either case, but the quickest way to assess for FBA is to auscultate the lungs.

Answer to Question 2

ANS: C
The Heimlich maneuver for a child over 1 year of age consists of giving abdominal thrusts until the object is dislodged or the child becomes unconscious. Abdominal thrusts are done by standing behind the child, wrapping your arms around the child, and placing the fist of one hand thumb side down into the child's abdomen, slightly above the umbilicus. You then squeeze the child's abdomen using rapid, forceful thrusting motions directed upward and inward. If the child becomes unconscious, begin CPR.