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You are a PNP in a busy tertiary PICU caring for an 8 year old admitted for dehydration secondary to feeding intolerance. History includes birth at 24 weeks gestation, cerebral palsy, profound developmental delay and GT dependence. The GI service was consulted and recommended strict NPO for 7-10 days. To provide adequate caloric and nutritional intake, you decide your patient requires total parenteral nutrition (TPN), and subsequently undergoes PICC line placement. The following statements are true regarding this clinical scenario except:

An 11 month old female is brought to the emergency department with an acute onset of intermittent, colicky abdominal pain, vomiting, lethargy, and “currant jelly” stools. Which of the following is the most likely diagnosis?

A 3 week old presents to the ED with a 2 day history of poor feeding, decreased urine output, and lethargy. On exam, it is noted that he has a bulging fontanelle. The child was born via spontaneous vaginal delivery and was discharged to home with mom on day 2 of life. In the ED, he was found to have a body temperature of 39.0 C (102.2 F). Before you prepare for a lumbar puncture, you are considering obtaining a CT scan of the head first. Why would this be indicated? 

Following surgery for a brain tumor, your 2 year old patient’s lab work shows a Na of 122 and serum osmo of 236. You cannot do an accurate neuro assessment due to the patient being intubated, sedated and paralyzed. What would be your next course of action?

Which of the following has a similar sedative effect as propofol?

Match the toxidrome with the correct statement about the substance:

A 11 year old male with Autism presents with severe dehydration secondary to diarrhea. IN the process of electrolyte evaluation and rehydration, he is noted to have excessive urine output and rising serum sodium levels. What is the most likely cause of these findings?

Steven, a 16-year-old high school student has been referred to your ED after he “jokingly” made a statement to his teacher that he was going to kill himself.  Your assessment indicates a high risk of suicide. Your initial action would be to:

A full-term newborn develops bilious emesis shortly after delivery. The pregnancy was complicated by polyhydramnios. Physical features are suggestive of trisomy 21. On exam, the newborn’s abdomen is soft and non-distended. What is the most likely diagnosis?

During your evening shift in the emergency department, you are asked to see a 9 month old female infant with 2 to 3 day history of several episodes of vomiting and diarrhea. The mother describes him as awake but moderately irritable. On examination, he is alert, with dry mucus membranes, a sunken fontanel, slightly sunken eyes, tachycardia, and 2 to 3 second capillary refill time. His serum Na level is 140. You estimate his percentage of dehydration to be: