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Pediatric Prioritization Questions - How to Answer Them on NCLEX

On to another triage question, but this one involves pediatrics. Do not forget about reviewing vulnerable populations such as pediatrics, obstetrics, the elderly, or the incarcerated for their unique clinical needs.

A 4-year-old Hispanic female presents to the Emergency Department (ED) with her Spanish-speaking parents. She was born at 35 premature and her NICU stay was complicated by bronchopulmonary dysplasia. She was diagnosed with asthma six months ago and has been using her albuterol inhaler as needed every 4 hours but without a spacer. Tonight, she went over to a friend's house to see their new kitty but started having trouble wheezing so they brought her to the ED when a dose of the albuterol failed to help alleviate her shortness of breath. She is wheezing and has dyspnea at rest. Her vitals are 90% on room air, 111 heart rate, 44 respirations, and a 98 degree F temperature. Your team is able to stabilize her in the ED. You anticipate what priority teaching needs prior to discharge?

(A) Education on avoiding asthma triggers, directions to use a rescue inhaler with a spacer, and a written asthma action plan in English

(B) Appropriate directions for using albuterol with a spacer and a referral for monthly Synagis

(C) Pulmonary risk factors that premature children face and when to use a rescue inhaler versus using a glucocorticosteroid.

(D) Education on avoiding asthma triggers, directions to use a rescue inhaler with a spacer, and a written asthma action plan in Spanish

Rationale:

So this question involves some of NCLEX tricks to throw a lot of information at you to bury what is really important. They almost give you too much information sometimes and you have to decide what you really need to pay attention to. In this case, they could be summed up with "Hispanic pediatric", "asthma exacerbation triggered by cat", and "administering inhaler without spacer"

(A) This is a great answer, but recall NCLEX wants "the best" answer. You might not pay attention to the end, because the case is long. But every word can be important in an answer or case. If you write the asthma action plan in English, likely the Spanish-speaking parents won't be able to read it. Since Joint Commission and various Federal Departments such as Health Resources and Service Administration have highlighted the importance of effective cultural and linguistic communication as a patient safety standard, having education in the right language is almost as important as giving the right medication.

(B) There is a sentence in the case about the past medical history of prematurity and bronchopulmonary dysplasia. This is a distracter. When you feel lost or confused, NCLEX authors know that it is easy to choose answers that you associate in your mind. It is easy to remember that premature children with respiratory issues usually do receive Synagis. However clinically, this child is too old for Synagis.

(C) This child might receive albuterol and a glucocorticosteroid when she leaves. However, this would not be a complete answer because it is also a standard of care that asthmatics receive an asthma action plan. Although pulmonary risk factor teaching would be appropriate for this patient, it is not the priority at the ED visit.

(D) This is the best answer because it covers the standards of care. This is because it includes an asthma action plan in the native language. Also, it covers appropriate medication teaching as most pediatric patients cannot use an inhaler without a spacer until they are an adolescent.

Reference

UpToDate. 2020. Acute Asthma Outpatient Management: Children.

Process:

Remember if you get overwhelmed by the length of a question or inundated with a lot of clinical data that it is important to sort out what is really important. What is the priority? What is the most important clinical information to know? This will help you simply to find the right answer.