464 prepu ch 13 - Key Pediatric Nursing Interventions
A health care provider has prescribed hydroxyurea 20 mg/kg to a child as part of a treatment regimen for sickle cell disease. The child weighs 27 lb (12.2 kg). How many milligrams should the nurse administer?
244
A nurse is providing care for a child diagnosed with beta-thalassemia. The child requires a blood transfusion of packed red blood cells (PRBCs). The health care provider has prescribed a transfusion volume of 10 ml/kg. The child weighs 37 lb (16.8 kg). How many milliliters should the nurse infuse?
168
A child is being discharged from the hospital and the nurse has completed discharge teaching regarding prescribed liquid medications. Which comments by the parent demonstrates understanding of discharge instructions for safe medication administration? Select all that apply. A "I will be sure to not give too much of the liquid medication at one time." B "I will only need one medicine dropper for both of the medications being prescribed." C "I shouldn't use a liquid dropper from my kitchen because it may be a different measurement than one from the pharmacy." D "I can probably pinch my child's nose to help in swallowing the medication. I do this when I don't want to taste a liquid medication." E "I need to make sure to use the medicine dropper the pharmacy gives me instead of the syringe I use for my B12 injections."
A "I will be sure to not give too much of the liquid medication at one time." C "I shouldn't use a liquid dropper from my kitchen because it may be a different measurement than one from the pharmacy." E "I need to make sure to use the medicine dropper the pharmacy gives me instead of the syringe I use for my B12 injections."
A child who is receiving TPN has developed the need to have insulin injections. The child's mother questions this and states that her child does not have diabetes. What is the appropriate response by the nurse? A "The feedings are high in sugar and insulin is needed to manage this." B "Illness can sometimes result in the need for insulin." C "There is no need to worry. This is temporary." D "There is a chance these feedings your child is receiving are causing her to have diabetes."
A "The feedings are high in sugar and insulin is needed to manage this."
A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2 saturation 95% on room air. Which action will the nurse take first? A Administer the bronchodilator via a nebulizer. B Give the antibiotic as prescribed. C Apply a cardiac monitor to the child. D Apply oxygen at 2 liters via a nasal cannula.
A Administer the bronchodilator via a nebulizer.
The nurse has prepared an IM injection to give a 13-year-old child. After some searching, the nurse locates the child in the playroom in front of a video game. Which action is best for the nurse to take? A Inform the child that it is time for an injection. Explain why the injection is needed and have the child move to the treatment room. B Ask the child to take a break from the game and come back to the child's room to give the injection. C Ask the child when the game will be over. D Give the injection in the playroom since the child is distracted with the video game.
A Inform the child that it is time for an injection. Explain why the injection is needed and have the child move to the treatment room.
As the nurse prepares to administer a medication to a preschooler, the nurse realizes that the child is extremely underweight for age. What action would the nurse take? A Measure the child's height and weight, and check whether the dose is correct for the child. B Give the child the prescribed dose, because dose is determined by nomogram, not weight. C Give the child one-half the prescribed dose. D Call the child's health care provider and alert the provider to the dosage error.
A Measure the child's height and weight, and check whether the dose is correct for the child.
A parent informs the nurse about having a hard time getting her 6-year-old child to take the liquid medication at home. Which would be the best suggestion for the nurse to offer the parent to help correct this concern? A Tell the parent to state firmly, "It's time for you to drink your medicine." B Tell the parent to ask the child nicely, "Will you drink this for me?" C Tell the parent to tell the child, "It tastes just like candy!" D Tell the parent to say calmly, "Can you drink this for me?"
A Tell the parent to state firmly, "It's time for you to drink your medicine."
When administering medications to an infant, what information will the nurse consider? A The oral medication should be directed toward the side of the mouth when using a syringe or dropper. B The infant will take oral medications more readily after he or she has been fed. C The infant will take a medication more readily if the flavor is disguised. D The infant will take medications more readily if he or she is allowed to move the head as desired.
A The oral medication should be directed toward the side of the mouth when using a syringe or dropper.
The nurse is preparing to administer an IV antibiotic to a child. After calculating the recommended dose with the child's weight, the nurse discovers the prescribed dose exceeds the safe dose range in a pediatric drug book. The medication has been given to the child at this dose for 3 days. What action should the nurse take next? A Verify the dose with the prescribing health care provider. B Ask the child's parents if this dose has been given all week. C Give the prescribed dose since the child has been receiving that dose for 3 days. D Call the pharmacy.
A Verify the dose with the prescribing health care provider.
The nurse is preparing to administer medication to a 10-year-old who weighs 70 lb (32 kg). The prescribed single dose is 3 to 4 mg/kg per day. Which dose range is appropriate for this child? A 105 to 140 mg B 96 to 128 mg C 210 to 280 mg D 420 to 560 mg
B 96 to 128 mg
A nurse is caring for a child having an arm laceration sutured. What intervention can the nurse provide that will help the child consider the procedure as not a totally negative experience? A Tell the child that the procedure was not as bad as he or she thought it would be. B Allow the child to choose a treat from the drawer. C Tell the child to be careful so that he or she will not have to return to the health care provider. D Be sure the parents are available to hold the child down so that there is decreased emotional trauma.
B Allow the child to choose a treat from the drawer.
The nurse is caring for a child with an ileostomy. What nursing intervention will be included in this child's plan of care? A Leave the ileostomy open to the air. B Check for leakage around the stoma. C Clean the outside of the collection device. D Apply a sterile dressing around the stoma.
B Check for leakage around the stoma.
A toddler requires 1.5 ml of an antibiotic given intramuscularly (IM). How will the nurse administer this medication? A Administer the antibiotic IM in the rectus femoris. B Divide the dose. Administer 0.75 ml IM in each vastus lateralis. C Reduce the volume of the dose using less diluent than recommended to prepare the antibiotic for IM injection. D Seek an order for an oral form of the antibiotic.
B Divide the dose. Administer 0.75 ml IM in each vastus lateralis.
Parents asks the nurse why their premature infant is receiving a feeding through the mouth rather than the nose. What is the best explanation by the nurse? A Orogastric tube insertion can cause inflammation and obstruction of the nares. B Newborns are obligate nose breathers so nasogastric may obstruct their breathing. C Nasogastric tubes decrease the possibility of striking the vagal nerve. D It is equally acceptable to use either insertion site.
B Newborns are obligate nose breathers so nasogastric may obstruct their breathing.
Included in the nursing care plan for the child receiving total parenteral nutrition (TPN) will be which intervention? A Flushing the peripheral catheter delivering the TPN solution regularly with saline B Regularly monitoring the child's blood glucose C A daily stool softener D Keeping the child nothing by mouth (NPO)
B Regularly monitoring the child's blood glucose
The nurse is caring for a comatose school-age child receiving gastrostomy tube feedings. The nurse aspirates 15 ml of stomach contents prior to administering a feeding. What is the appropriate action by the nurse? A Discard the stomach contents and continue with the feedings as prescribed. B Replace the stomach contents and continue with the feedings as prescribed. C Discard the stomach contents and notify the health care provider of the aspiration amount. D Replace the stomach contents and hold the feeding.
B Replace the stomach contents and continue with the feedings as prescribed.
The parents of a 2-year-old child have been taught how to administer ear drops to their child. Upon return demonstration, what action(s) by the parents would require re-education by the nurse? Select all that apply. A The parent rolls the bottle of medication between the palms before administration. B The parent pulls the pinna of the ear up and back. C The parent keeps the child's head in the same position after administration for approximately 30 seconds. D The parent places the tip of the medication dropper into the ear canal prior to administration. E One parent helps keep the child still while the other parent instills the medication.
B The parent pulls the pinna of the ear up and back. C The parent keeps the child's head in the same position after administration for approximately 30 seconds. D The parent places the tip of the medication dropper into the ear canal prior to administration.
The nurse is teaching parents of a 12-year-old child how to administer otic medication. Which statement by the parent indicates a need for further education? A "I will hold the dropper 0.5 in (1.25 cm) above the ear canal and be certain not to touch the ear with the dropper." B "After removing the medication from the refrigerator, I need to roll it gently in my palms to warm it." C "I will pull the outer ear down and back before administering the medication." D "After administering the drops, I will ask my child to remain side-lying for several minutes."
C "I will pull the outer ear down and back before administering the medication."
The nurse has been caring for a 12-year-old boy during his 5-day hospitalization. The child's IV has infiltrated, and the care provider is getting ready to change the intravenous line site. Which statement made by the nurse would be appropriate in supporting the child? A "The nurses on the unit know the client well, so maybe a nurse could start the IV." B "I will be back after your IV is in place." C "The client is left-handed and likes to draw; an IV site in his right arm would be best." D "Would you like me to stay with you or are you OK alone?"
C "The client is left-handed and likes to draw; an IV site in his right arm would be best."
The nurse is preparing to administer an intramuscular immunization to a 5-year-old child. What statement to the child is appropriate for inclusion in the preadministration period? A "I am going to give you an immunization." B "If you don't hold still it will hurt more." C "This will help prevent you from getting sick." D "This shot will help you."
C "This will help prevent you from getting sick."
The nurse is showing the student nurse how to flush a pediatric client's peripherally inserted central catheter (PICC) line. The nurse prepares a 3-ml normal saline flush using a 5-ml syringe. The student asks the nurse why the flush was prepared this way. What is the most accurate response by the nurse? A "The 5-ml syringe is what we have the most stock of so I just always use it." B "I like how the 5-ml syringe fits in my hand. I feel like I have a better grip on it than a smaller syringe." C "Using a larger-volume syringe exerts less pressure on the PICC line." D "It is standard policy in our facility to use a 5-ml syringe for all PICC line flushes."
C "Using a larger-volume syringe exerts less pressure on the PICC line."
A 4-year-old child is being prepared to undergo a bronchoscopy to remove an aspirated pea. The nurse knows that the parents need additional teaching based on which statement? A "We can go with our child to the holding area and stay with him until the procedure starts." B "The health care provider will put a tube into my child's throat to remove the obstruction." C "We will be able to take our child home immediately after the procedure is completed." D "Our child will be sedated during the procedure."
C "We will be able to take our child home immediately after the procedure is completed."
A neonate is to receive a hepatitis B vaccine within a few hours after birth. What is the best approach for the nurse to take when giving this medication? A Administer the medication in the vastus lateralis with a 20-gauge needle. B Administer the medication in the dorsogluteal with a 25-gauge needle. C Administer the medication in the neonate's vastus lateralis with a 25-gauge needle. D Administer the medication in the deltoid muscle with a 20-gauge needle.
C Administer the medication in the neonate's vastus lateralis with a 25-gauge needle.
A nurse is preparing to start an IV for a 3-year-old child. Which nursing action(s) is appropriate for a child this age? Select all that apply. A Use the antecubital vein for easy access. B Ask the parent to wait outside the treatment room. C Explain the procedure using positive language. D Allow the child to touch safe equipment in the treatment room. E Have another nurse hold the child during the procedure. F Give the child a sticker when finished.
C Explain the procedure using positive language. D Allow the child to touch safe equipment in the treatment room. E Have another nurse hold the child during the procedure. F Give the child a sticker when finished.
When assessing a caregiver's knowledge of proper medication administration, which is the best way for the nurse to determine the caregiver's knowledge? A Have the caregiver verbalize the exact steps in how to properly administer the prescribed medications. B Have the caregiver watch the nurse give the medications using proper administration techniques. C Have the caregiver give a demonstration of the medication administration to the nurse before discharge. D Encourage the caregiver to ask the nurse questions about proper medication administration before discharge.
C Have the caregiver give a demonstration of the medication administration to the nurse before discharge.
The nurse is administering an oral liquid medication to a 5-year-old child. What would be the most appropriate for the nurse to do when administering this medication? A Ask the parent to hold the child's arms during administration. B Administer the medication using a dropper. C Let the child hold the medication cup. D Have the child lying down with the head elevated on a pillow.
C Let the child hold the medication cup.
A nurse inserts a nasogastric (NG) tube into a child for enteral feeding. How will the nurse ensure appropriate placement of the tube after insertion? A Conduct pH testing. B Aspirate gastric contents. C Obtain radiologic confirmation. D Inject 30 mL of air and listen over the epigastrium.
C Obtain radiologic confirmation.
What is the best method for the nurse to reduce the pain of an IM injection for a child? A Administer the injection while the child is asleep. B Remind the child that this will not hurt. C Request an anesthetic cream to apply before injection. D Tell the child that it is best not to cry.
C Request an anesthetic cream to apply before injection.
The nurse is preparing to give a diphtheria, pertussis, and tetanus (DPT) immunization to a child in an acute care setting before discharge. The label on the DPT bottle indicates the immunization expired yesterday. What is the correct nursing action to take? A Discard the bottle. B Inform the prescribing practitioner. C Return the bottle to the pharmacy and request a replacement. D Give the injection since it is only one day expired.
C Return the bottle to the pharmacy and request a replacement.
The nurse is administering a gavage feeding through a nasogastric feeding tube. Which nursing intervention is the highest priority? A The nurse replaces stomach content that has been aspirated. B The nurse documents how the child tolerated the feeding. C The nurse verifies the position of the feeding tube. D The nurse positions the child in a sitting position.
C The nurse verifies the position of the feeding tube.
The nurse is working to gain a preschooler's cooperation to swallow an oral medication. What would be the nurse's best approach? A compare the taste of the medicine to a chocolate bar B offer to play a game with the child if the child takes the medicine C ask if the child would like to take the medicine in a cup or through an oral syringe D leave the medicine on the night stand so the child can take it independently
C ask if the child would like to take the medicine in a cup or through an oral syringe
A medical/surgical nurse has been floated to the pediatric unit. Which action by the float nurse would require the pediatric nurse to intervene? A speaking to both the parents and child about medications B scanning the child's barcode on the identification band C asking the child his or her name prior to giving medications D requesting the pediatric nurse to double-check calculations
C asking the child his or her name prior to giving medications
The nurse is preparing an emergency IV site for a child who has been admitted to the hospital with burns on his arms, legs, and torso. Which IV site would be most appropriate? A antecubital B scalp C intraosseous D femoral
C intraosseous
When preparing to administer medication to an infant, the nurse should utilize which device? A measured medication spoon B infant formula and bottle C oral syringe without a needle D medicine cup
C oral syringe without a needle
The nurse is preparing to administer albuterol to a 14-year-old client for the first time. Prior to administration, which adverse reaction is priority for the nurse to educate the client? A hypoactivity B increased appetite C tachycardia D bronchial muscle relaxation
C tachycardia
The primary health care provider prescribed ketoconazole for a child with ringworm. Which statement by the parents indicates the nurse needs to provide additional teaching on the prescription? A"I will wash my hands before and after I apply this medication." B"If this medication gets in my child's eyes, I will rinse with water immediately." C "My child needs to take the full prescribed dosage." D "I will wrap the skin tightly after applying the medication."
D "I will wrap the skin tightly after applying the medication."
The nurse has finished completing a client education program for parents on proper medication administration to children. Which statement by a parent would indicate a need for further education? A "I will put my daughter's pill in a small amount of applesauce to help her learn now to swallow it." B "I will let my preschooler squirt his medication in his own mouth after I have measured it out." C "When I give my toddler medication, I will make sure they are sitting up." D "If my toddler won't swallow her medication, I will hold her nose until she has to swallow."
D "If my toddler won't swallow her medication, I will hold her nose until she has to swallow."
The mother of a 9-year-old girl calls the physician's office complaining that her daughter continues to vomit soon after being given an oral amoxicillin capsule for her strep throat. The nurse recognizes that the child's vomiting will interfere with which pharmacokinetic process? A Metabolism B Excretion C Distribution D Absorption
D Absorption
A nurse is preparing a dose of insulin to give the client. Which action takes priority when preparing and administering this medication? A Have another RN witness the injection given to the client. B Double-check the math calculations. C Ask the client if he or she has had any adverse reactions to insulin in the past. D Double-check the dose with another RN before giving.
D Double-check the dose with another RN before giving.
While working in the emergency room, the nurse receives a call that a 3-year-old child sustained extensive burns in a house fire. Assuming all of the following actions are included in the standing burn-care protocol, which action should be the nurse perform first? A Insert a nasogastric tube to empty the stomach. B Ask the child to drink a glass of milk. C Give a tetanus toxoid injection. D Obtain a weight.
D Obtain a weight.
A child is having difficulty swallowing pills. What is the best action for the nurse to take to help this child swallow medications? A Crush all medications and dissolve in water. B Obtain small round candy to practice swallowing techniques. C Hold the medication and notify the health care provider. D Place the pills in a bite of ice cream or applesauce.
D Place the pills in a bite of ice cream or applesauce.
A nurse is administering ear drops to a 7-year-old girl. What should the nurse do? A Warn the child that the drops will hurt. B Hold the child's head in the sideways position while counting to 5 to ensure the medication fills the entire ear canal. C Administer the medication while it is still cold from the refrigerator. D Pull the pinna of the ear up and back to straighten the external ear canal.
D Pull the pinna of the ear up and back to straighten the external ear canal.
The nursing student identifies which technique as the correct one to use when giving oral medications to an infant? A Use a dropper and squirt the liquid quickly into the back of the infant's mouth. B Use a dropper and let it rest on the infant's tongue when squirting the medicine. C Allow the child to lay flat while giving the liquid medication to relax the child. D Use a dropper and slowly inject the liquid into the side of the infant's mouth.
D Use a dropper and slowly inject the liquid into the side of the infant's mouth.
The charge nurse is assisting the new graduate nurse in administering eye drops to a child. The charge nurse would stop the new graduate if which action was observed? A allows the child to sit up after blinking a few times B administers drops into conjunctival sac C positions the child supine on the bed D holds the eyelids apart for about 30 seconds
D holds the eyelids apart for about 30 seconds
At what point does a child convert to the adult dosing for medication administration? A when the child reaches the age of 16 years B when the child reaches the age of 12 years C when the child reaches a weight of 100 lb (45 kg) D when the child reaches a weight of 110 lb (50 kg)
D when the child reaches a weight of 110 lb (50 kg)