Certified Pediatric Emergency Nurse (CPEN) Practice Exam

What is the most appropriate next step for a 12-year-old boy in shock, after providing 100% oxygen by mask?

1. Check circulation of toes of the affected leg

2. Establish IV access

3. Provide oral analgesics as ordered

4. Position the boy on his back with head elevated

The correct answer is: Establish IV access

The most appropriate next step for a 12-year-old boy in shock, after providing 100% oxygen by mask, is to establish IV access. In the context of shock, there is often a deficit in the circulatory system, which can lead to inadequate perfusion of vital organs. Providing 100% oxygen is essential to improve oxygen delivery; however, the underlying issue typically relates to blood volume or circulation. Establishing IV access allows for the provision of necessary fluids, such as crystalloids or blood products, which are critical in the management of shock. This intervention helps to restore hemodynamic stability by addressing the hypovolemia or other fluid deficiencies promptly. Rapid IV access can also facilitate the administration of medications if needed. Other choices, while relevant to the overall care of a child in shock, do not address the immediate need for fluid resuscitation and stabilization as directly as establishing IV access. Checking circulation may provide useful information but does not effectively intervene in the shock state. Providing oral analgesics is inappropriate in a situation where oral intake may be compromised and the child may require more urgent intervention. Positioning the boy on his back with his head elevated can be helpful, but it does not take precedence over the establishment of IV