A 15-year-old male with a known anterior mediastinal mass presents with progressive facial swelling, a headache that worsens when bending forward, and dyspnea that worsens in the supine position. SpO2 is 93% on room air and he is increasingly anxious. Which nursing intervention is the highest priority?

A 3-week-old neonate presents with poor feeding, diaphoresis with feeding, and pallor. Heart rate is 170 bpm, respiratory rate is 60 per minute, and the liver edge is palpable 4 cm below the right costal margin. A loud holosystolic murmur is heard at the left sternal border. SpO2 is 96% on room air. Which pathophysiologic process best explains this presentation?

A 4-week-old male is brought in with 10 days of forceful, nonbilious vomiting immediately after every feeding. The infant appears hungry after each episode. Serum chemistries return: sodium 138 mEq/L, potassium 3.1 mEq/L, chloride 87 mEq/L, bicarbonate 31 mEq/L. Which metabolic pattern is most consistent with this presentation?

A 5-year-old with severe autism spectrum disorder is brought in after a fall. The child is nonverbal, does not make eye contact, and cannot follow instructions. Which approach to pain assessment is most appropriate?

A 2-year-old with 5 days of fever presents with HR 158, RR 36, and BP 78/42 mmHg. Laboratory results show: WBC 22,000 cells per microliter with 18% bands, CRP 142 mg/L, and serum lactate 3.8 mmol/L. How should the nurse interpret the serum lactate level?

An 8-month-old is being assessed for possible dehydration after 36 hours of decreased feeding. The nurse gently pinches and releases a fold of skin over the infant’s abdomen and observes that the skin slowly returns to its normal position over approximately 3 seconds. How should the nurse document and interpret this finding?

A 15-year-old male presents after ingesting an unknown substance at a party. He is agitated and diaphoretic with a temperature of 40.6 degrees Celsius, heart rate of 140 bpm, and blood pressure of 148/92 mmHg. Neurological examination reveals bilateral lower-extremity clonus and pupils measuring 7 mm bilaterally. Which toxidrome most accurately explains this clinical picture?

A 12-year-old boy is brought to the ED after being bitten on the finger while hiking in the southeastern United States by a small snake whose red bands were bordered on each side by yellow bands, alternating with black bands. The bite site shows only minimal local swelling and the child is currently asymptomatic. Which statement best guides his management?

A 10-month-old infant who is not yet pulling to stand is brought to the ED by a caregiver who states the baby rolled off the couch. X-ray reveals a displaced mid-shaft femur fracture. Which statement best characterizes this clinical situation?

A triage nurse is scanning the waiting room and observes four children. Which child should be evaluated immediately based on the across-the-room assessment?

A 9-year-old triaged as level 3 for a laceration reports to the triage desk that he feels lightheaded and his bandage is saturated with blood. The triage nurse’s priority action is to:

A 2-year-old arrives by EMS after being found unresponsive in his crib. He is flaccid, has a heart rate of 55, respiratory rate of 6, and grunting respirations. What should the triage nurse do first?

A 22-month-old presents with 4 days of fever and a petechial rash over the trunk and lower extremities. On assessment: temperature 40.2°C, HR 186 bpm, BP 62/36 mmHg, RR 48/min, capillary refill 7 seconds, mottled skin, and altered mental status. Two sequential fluid boluses of 20 mL/kg each have been administered over 30 minutes with no hemodynamic improvement. What is the most appropriate next step?

A 12-year-old with moderate persistent asthma requires procedural sedation for incision and drainage of a large gluteal abscess. Which sedation agent is most appropriate for this patient?

A 12-year-old with traumatic hemorrhagic shock activates the pediatric massive transfusion protocol. Which packed red blood cell to fresh frozen plasma to platelet ratio best reflects current evidence-based recommendations?

A pediatric ED implements a new sepsis recognition and bundle compliance tool. After three months, bundle compliance is measured at 62%, below the 90% target. Using a Plan-Do-Study-Act framework, the team’s most appropriate next step is:

A nurse preparing to administer a weight-based antibiotic to a 5-year-old notes that the medication administration record lists the patient’s weight as 28 kg, but the child appears to weigh significantly less based on clinical assessment. The nurse’s most appropriate action is:

The parents of a 12-year-old newly diagnosed with a serious condition ask the nurse not to share the diagnosis with their child, citing deep cultural and religious values. The child has been repeatedly asking what is wrong with her. Which ethical principle is most directly in tension with honoring the parents’ request?