Pediatric ATI Practice Exam

After stabilizing an 8-year-old child's respirations, what is the next appropriate action for the nurse when assessing for early indications of shock?

1. Insert an indwelling urinary catheter.

2. Measure weight and height.

3. Initiate IV access.

4. Maintain ECG monitoring.

The correct answer is: Initiate IV access.

After stabilizing the child's respirations, initiating IV access is critical for ongoing assessment and intervention in the event of shock. IV access allows for rapid administration of fluids and medications if the child's condition deteriorates. In cases of early shock, timely fluid resuscitation may be necessary to maintain adequate circulation and perfusion to vital organs. Establishing an IV line enables the healthcare team to respond quickly to changes in the child's hemodynamic status, which is crucial in managing potential shock effectively. In contrast, inserting an indwelling urinary catheter is often not an immediate priority at this stage since it does not assist in the rapid assessment or management of shock. Measuring weight and height is not directly related to the assessment of shock and would not provide timely information about the child's current status. Maintaining ECG monitoring is important, but it is typically part of a broader continuous assessment rather than the immediate next step after addressing respirations. Therefore, the choice to initiate IV access is centered around the urgent need for potential intervention in shock management.