Pediatrics: PrepU: Chapter 13
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 Explanation: The nurse will use the client's weight in kilograms and multiply by the prescribed milliliters/kilogram 16.8 kg × 10 ml PRBCs = 168 mLl
What method would the nurse use to teach an 8-year-old client how to swallow medications?
Have the child practice swallowing an ice chip. Explanation: Hiding the pill in applesauce or crushing it may help the child swallow it easier, but it does not teach the child how to swallow a pill. The nurse should have the child practice swallowing a small piece of ice, as it will melt and not get stuck in the throat. It is best to put the pill as far back on the tongue to make it easier to swallow.
The parent of a child with a central venous catheter expresses concern about whether the catheter could fall out when the child goes home. What is the nurse's best response?
There is a tiny cuff under the skin that secures the catheter. Explanation: Central venous catheters have a wrinkle-resistant fabric cuff that adheres to the subcutaneous tissue and helps to seal the catheter in place and keep out infection. The cuff does not cushion the tubing, facilitate flushing, or prevent rejection.
A 4-year-old child is admitted to the hospital for surgery. Before the nurse administers medicine, the best way to identify the child would be to:
read the child's armband. Explanation: A child may answer to the wrong name or deny his or her identity to avoid an unpleasant situation or if scared of the unknown. If the child is avoiding the situation he or she may fail to answer. Using the child's nickname is okay in conversation but it is not a legal identification of the child. To verify the correct identity the nurse should verify the child's armband and the correct name with the child's caregiver. Bar code scanning the child's armband would also be a correct method of identification.
A child with HIV, weighing 25 kg (55.1 lbs), is about to receive an infusion of IVIG. The recommended dose is 400 mg/kg/dose. The medication is available in a concentration of 50 mg/mL. What is the proper amount of infusion that the child will receive?
200 mL Explanation: The dose is calculated as 25 x 400 = 10,000 mg. Because the concentration is 50 mg/mL, calculate the volume as 10,000/50 = 200 mL.
A 5-year-old boy is receiving an analgesic intravenously while in the hospital. What should the nurse do to determine whether the drug is being properly excreted from this child?
Monitor the childs fluid intake & output
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?
Newborns are obligate nose breathers so nasogastric may obstruct their breathing. Explanation: Whether enteral catheters should be passed through the nares or the mouth is controversial. Because newborns are obligate nasal breathers, passing a catheter through the nose may obstruct their breathing space, and repeated insertion of a nasogastric tube can cause inflammation and obstruction of the nose; thus most tubes are inserted orally in small infants. Orogastric insertion can also decrease the possibility of striking the vagal nerve in the back of the throat and causing bradycardia, whereas nasogastric tubes increase the possibility of striking the vagal nerve.
The nurse is mentoring a newly graduated nurse on the pediatric unit. Which action by the new nurse requires further instruction when preparing an intramuscular injection for a 6-month-old? Select all that apply.
The nurse prepares to administer 0.7 mL of solution using one injection The nurse prepares to inject the medication into the ventrogluteal site Explanation: No more than 0.5 mL of medication should be administered intramuscularly to an infant, and the preferred site is the vastus lateralis muscle due to muscle development. A 5/8 to 1 inch, 22-25 gauge needle is the preferred range for an infant. Viscosity (thickness) of the medication must be considered when choosing the needle size in order to ensure proper administration.
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?
We will be able to take our child home immediately after the procedure is completed." Explanation: The child will not leave immediately. Procedural complications are not common but may include compromise to the airway such as hemorrhage, pneumothorax, and airway edema. After the procedure, the nurse will need to continue to assess the child's respiratory function and airway patency. Postprocedure complications may include bronchospasm, stridor, desaturation, or respiratory distress. The nurse will observe children carefully the first time they drink after the procedure to assess that the gag reflex is intact and they do not choke. All of the other options are correct.
What are possible complications for a child with a vascular access port? Select all that apply.
infection thrombosis hemorrhage air embolism
A nurse has just given otic medication instructions to the parents of a 12-year-old child. Which statement would indicate that the parents need further education concerning the medication?
"I will pull the outer ear down and back before administering the medication." Explanation: The proper technique to instill ear drops in a child older than age 3 involves pulling the pinna up and back. Otic medication should not be administered if it is cold. Cold medication may cause discomfort and produce vomiting or vertigo in the child. If an otic medication must be refrigerated, it should be warmed to room temperature in the palms of the hands. Proper otic administration technique involves holding the dropper 0.5 in (1.25 cm) above the ear canal and being careful not to touch the dropper to the ear to prevent contamination of the dropper with microorganisms. For children young than 3, the parent would pull the pinna down and back.
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.
"I need to make sure to use the medicine dropper the pharmacy gives me instead of the syringe I use for my B12 injections." "I shouldn't use a liquid dropper from my kitchen because it may be a different measurement than one from the pharmacy." "I will be sure to not give too much of the liquid medication at one time." Only droppers given by the pharmacy for the specific medication should be used. Different syringes may have different measurements than pediatric oral syringes. Mixing medication syringes is avoided if a dropper is packaged with a certain medication since the drop size may vary from one dropper to another. Giving small amounts of liquid avoids aspiration. Pinching the child's nose increases the risk for aspiration and interferes with the development of a trusting relationship.
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?
"I will wrap the skin tightly after applying the medication." Explanation: Ketoconazole is an antifungal used to treat tinea infections. The nurse would teach to avoid covering treated skin areas with tightly. The area needs to allow for air to circulate to the skin in order to limit side effects. All other statements indicate correct understanding.
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?
"The feedings are high in sugar and insulin is needed to manage this." Explanation: Glucose levels may be elevated when TPN is administered. While illness can impact serum glucose levels, this is not an appropriate response. Telling the parent there is no need to worry minimizes concerns and is not a correct response. The child does not have diabetes but warrants insulin coverage.
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?
"This will help prevent you from getting sick." Explanation: When providing teaching to a child it is important to be open, honest and provide developmentally appropriate information. Explaining that this will prevent later illness is something a child can understand. Saying that pain may result if movement occurs is a scare tactic and counterproductive. Yes, this is an immunization but this is terminology that is too complex for a child. Using the word "shot" is scary for the child and should not avoided if possible.
The nurse is educating the parents of a 5-month-old on how to administer an oral antibiotic. Which response indicates a need for further teaching?
"We can mix the antibiotics into his formula or food." Explanation: Never mix a medication with formula or food. The child may associate the bitter taste with the food and later refuse to eat it.
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 Explanation: The nurse will use the client's weight in kilograms and multiply by the prescribed milliliters/kilogram 16.8 kg × 10 ml PRBCs = 168 mLl
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 Explanation: The nurse will use the client's weight in kilograms and multiply by the prescribed milligrams per kilogram. 12.2 kg × 20 mg/kg = 244 mg
The nurse is caring for a 12-year-old post-appendectomy client who weighs 86 pounds. The child has a temperature of 38.5ºC (101.3ºF). The nurse prepares to give the client a dose of oral acetaminophen. The order reads "Tylenol 15mg/kg/dose every 4 to 6 hours PO PRN for fever or pain." How many milligrams of Tylenol should the nurse give the client?
587 milligrams Explanation: The child's weight must first be converted to kilograms by dividing 86 by 2.2. The result is 39.1 kilograms. Next, the 39.1 kilograms must be multiplied by 15 milligrams. This answer is 587 milligrams.
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?
Administer the bronchodilator via a nebulizer. Explanation: The nurse would first administer the bronchodilator to open the child's airway and facilitate breathing. Once the airway was open, the nurse could administer oxygen, if indicated. At this time, the child's saturation level is normal but it should be monitored. The nurse would then administer the antibiotic medication. The heart rate is within normal range for a child of this age (65 to 110 beats/minute); therefore, a cardiac monitor is not needed at this time.
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?
Administer the medication in the neonate's vastus lateralis with a 25-gauge needle. Explanation: The vastus lateralis site is a safe choice for intramuscular (IM) injections in a neonate. A 22- to 25-gauge needle is recommended for neonates, but the nurse must assess the neonate's size before determining needle size to use. The 25-gauge needle is recommended for neonates. The dorsogluteal site should not be used until school age. Neither the deltoid muscle nor the dorsogluteal muscle are recommended IM sites for neonates. These muscles should not be used until toddler age or older. The volume of the medication should not exceed 0.5 ml per injection until the child is preschool age.
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He needs to take his medicine or he will lose a privilege." The nurse should emphasize that the parents should never threaten the child in order to make him take his medication. It is more appropriate to develop a cooperative approach that will elicit the child's cooperation since he needs ongoing, daily medication. The other statements are correct.
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?
Obtain a weight. Explanation: A burn victim will require large amounts of fluid hydration to replace fluid losses. Obtaining a weight provides a base for calculating the fluid that will need to be replaced. Nasogastric tube placement and/or drinking milk are not actions to take at this point. Tetanus can be given later and is not critical to active management.
A child is having difficulty swallowing pills. What is the best action for the nurse to take to help this child swallow medications?
Place the pills in a bite of ice cream or applesauce. Explanation: The most useful technique when children cannot swallow pills is to put them into some ice cream or applesauce. This allows the medication to be administered in the original form. The nurse should not use candy for practice, because this may suggest to the child that medicine is the same as candy. The nurse should never crush medications which are enteric coated or time released. The nurse shoul
The nurse is preparing to give a 4-month-old an oral medication. Which technique demonstrates the nurse's accurate knowledge of the infant's developmental level?
Position the infant upright, offer the infant a bottle of formula, remove the bottle and squirt the medication on the side of the tongue toward the cheek, then offer the infant the bottle again.
the nurse wishes to promote gastric emptying after administering the preschooler's gastrostomy feeding. Which position will facilitate this?
Right side-lying The right side-lying position should be chosen because the stomach empties into the intestine in this direction. It is also helpful to elevate the child's head slightly to prevent reflux of the feeding into the esophagus.
When administering medications to an infant, what information would be most important for the nurse to consider?
The oral medication should be directed toward the posterior side of the mouth when using a syringe or dropper.] A syringe or dropper should be directed toward the posterior side of the mouth with the infant in the upright position when administering an oral medication.
The student nurse is preparing to care for a recently placed gastrostomy tube. Which action would prompt further instruction from the overseeing nurse?
The student obtains an antimicrobial soap to clean the area surrounding the tube. Explanation: The skin around a gastrostomy tube requires cleaning at least once a day. Routine site care includes gentle cleansing with sterile water or saline for newly placed tubes, or for established tubes, soap and water followed by rinsing or cleaning with water alone. To clean under an external disc or bumper, a cotton-tipped applicator may be used.
A nurse is preparing to give an intramuscular (IM) injection to an infant. Which site does the nurse identify as mandatory for this administration?
Vastus lateralis muscle For IM injections in infants, the mandatory site for administration is the vastus lateralis muscle of the anterior thigh. This site should be used for all IM injections in infants younger than 7 months of age. After 7 months of age, the ventrogluteal muscle can be used also. The dorsogluteal muscle should not be used for children. The muscles are not fully developed and the sciatic nerve occupies a large portion of this area. The deltoid muscle is used for older children as well as for adults.
The site most often used when administering a medication using the intradermal route is the:
forearm. Explanation: Intradermal injections deposit medications just under the epidermis. They are most often used for tuberculosis screening and allergy testing. The forearm is the site most often used. The anterior thigh, lateral upper arms, and abdomen are the preferred sites for subcutaneous administration. The deltoid, vastus lateralis and the ventrogluteal are the preferred sited for intramuscular injections.
A family the nurse is working with administers cycled total parenteral nutrition (TPN) over a 12-hour period at night to free their teenage son for activities during the day. In teaching this family, what areas would the nurse stress? Select all that apply.
Administering the solution at half-rate during the first and last hour of the infusion Inspecting the insertion site of the catheter regularly
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?
Let the child hold the medication cup. Explanation: Droppers and oral syringes can be used to administer medications to infants and young children. Medication cups and spoons can be used to administer liquid medications to the older child. The child can hold the medication cup and drink the liquid medication. Depending upon the age of the child, he or she may still prefer to take liquid medications via the syringe. It makes taking the medication fun when the child can squirt it into the mouth by himself or herself. The child who is lying down when being given medications should have the head of the bed elevated to at least 45 degrees A 5-year-old child does not need to be restrained for medication administration.
A pediatric client is having difficulty breathing. Which nursing intervention is appropriate for this client?
Provide oxygen as needed to maintain oxygen saturation above 93% Explanation: The nurse would provide oxygen to increase oxygen saturation as needed for this child. A decrease in oxygen saturation will cause the child to have an increase in the work of breathing. The positioning does not promote an open airway. Having family members leave the room could increase the child's anxiety, which would worsen the respiratory status. Continuing to monitor the child provides no assistance or relief.
In caring for the child with asthma, the nurse recognizes that bronchodilator medications are administered to children with asthma for which reason?
Relief of acute symptoms Explanation: Bronchodilators are used for quick relief of acute exacerbations of asthma symptoms. Mast cell stabilizers help to stabilize the cell membrane by preventing mast cells from releasing the chemical mediators that cause bronchospasm and mucous membrane inflammation. Leukotriene inhibitors are given by mouth along with other asthma medications for long-term control and prevention of mild, persistent asthma. Bronchodilators are not effective for pain.
The nursing student identifies which technique as the correct one to use when giving oral medications to an infant?
Use a dropper and slowly inject the liquid into the side of the infant's mouth. Explanation: When giving liquid medication to an infant or child, the nurse should never administer it while the child is flat. Doing so could cause a child to aspirate. The nurse uses the dropper by placing it so the fluid flows slowly into the side of the child's mouth. The nurse should make sure the end of the syringe rests at the side of the infant's mouth to help prevent aspiration as well.
he new graduate nurse is preparing to administer medication to a 4-year-old client. When would it be appropriate for the supervising nurse to intervene? The new graduate:
had two whole tablets to administer to the child. Explanation: Many children do not have enough coordination to swallow tablets or pills until they are 6 or 7 years of age. Therefore, the supervising nurse would need to intervene. The other actions are correct. The nurse should explain why the medication is being administered. Medications in children are dosed according to body weight (milligrams per kilogram) or body surface area (BSA) (milligrams per square meter). The vastus lateralis is a good location for an IM injection in a 4-year-old child. Reference:
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?
intraosseous Explanation: Intraosseous infusion is used in an emergency when it is difficult to establish usual IV access or in a child with such extensive burns that the usual sites for IV infusion are not available. The other sites would not be available in this situation.
The nurse is administering an intramuscular injection of an antibiotic to a 3-month-old infant. Which would be the best site for the nurse to give this medication?
vastus lateralis muscle The muscle preferred for intramuscular injections in the infant less than 7 months of age is the vastus lateralis, located on the thigh. The ventrogluteal and deltoid are used in older children to adults. The dorsogluteal is no longer considered suitable for an intramuscular injection due to the risk of injury to the sciatic nerve.
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?
"Using a larger-volume syringe exerts less pressure on the PICC line." Explanation: Using a larger-volume syringe (i.e., 5 mL or larger) exerts less pressure on the PICC, thereby reducing the risk of rupture.
The nurse is calculating the urinary output for the infant. The infant's diaper weighed 40 grams prior to placing the diaper on the infant. After removal of the wet diaper, the diaper weighed 75 grams. How many milliliters of urine can the nurse document as urinary output? Record your answer using a whole number.
35 Explanation: The diaper must be weighed before being placed on the infant and after removal to determine urinary output. For each 1 gram of increased weight, this is the equivalent of 1 milliliter of fluid. 75 grams - 40 grams = 35 grams = 35 mL
The adolescent weighs 113 lb (51.36 kg). The nurse closely monitors the child's urine output. How many milliliters of urine is the least amount that the adolescent should make during an 8-hour shift? Record your answer using a whole number.
411 Explanation: The child weighs 113 lb (51.36 kg). 51.36 kg x 1 mL/1 kg = 51.36 mL/hour. 51.36 x 8 hours = 410.90. Rounded to the nearest whole number = 411 mL
A child needs a peripheral IV start as well as a venous blood sample for a laboratory test. The nurse will take what action?
Coordinate placing the peripheral IV and the lab blood draw. Explanation Coordinate the IV placement and lab blood draw to minimize the number of venipunctures for the child. Gaining venous access for each purpose separately does not do this and is not necessary. Having a well-hydrated child makes venous access easier, but oral hydration will take some time, thus delaying needed treatment.
A nurse is administering ear drops to a 7-year-old girl. What should the nurse do?
Pull the pinna of the ear up and back to straighten the external ear canal. Explanation: Remind the child ear drops can feel odd, as if someone were tickling the ear. Ear drops must always be used at room temperature or warmed slightly as cold fluid, such as medication taken from a refrigerator, does cause pain and may also cause severe vertigo as it touches the tympanic membrane. If the child is older than 2 years, pull the pinna of the ear up and back. Instill the specified number of drops into the ear canal. Hold the child's head in the sideways position while you count to 60 to ensure the medication fills the entire ear canal.
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?
Verify the dose with the prescribing health care provider. Explanation: Medication calculations should always be checked before giving the dose. When a medication dose is found to be outside of the safe dose range, the dose should be verified with the prescribing health care provider. Doses that exceed the recommended range should always be verified, even if they have been given before. The parents did not prescribe this medication. Even if the medication has been given for 3 days, it does not make the dose correct. Calling the pharmacy can only verify if the dose is out of the safe range. The pharmacy did not prescribe the medication nor does it know the child's medical background.
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?
holds the eyelids apart for about 30 seconds Explanation: To prevent the conjunctiva from drying, the nurse should not hold the eyelids apart any longer than necessary. Therefore, the charge nurse would need to stop the new nurse. It is best to use the supine position. Instill the correct number of drops into the conjunctiva of the lower lid. Allow the eyelid to close. Avoid placing the drops directly on the cornea because that can be painful. To prevent the conjunctiva from drying, do not hold the eyelids apart any longer than necessary. After the child has blinked 2 or 3 times, allow the child to sit up.
The nurse is preparing to remove an IV device from the arm of a 6-year-old girl. Which approach is best for minimizing fear and anxiety?
Ask the child if they would like to help remove the tape from the IV. The nurse needs to openly discuss the procedure with the child at an age appropriate level. The nurse should explain what is to occur and enlist the child's help in the removal of the tape or dressing. This provides the child with a sense of control over the situation and also encourages his or her cooperation. The nurse should avoid using scissors to remove the tape or dressing and the comment regarding cutting may be perceived as threatening and/or frightening. The procedure may be minorly uncomfortable so it is best to be honest with the child.
The nurse is caring for a 13-year-old client. The nurse prepares and verifies several medications and brings them and the medication administration record to the client's room. The nurse observes that the client is not wearing an identification band. Which action will the nurse to take?
Ask the client to recall his or her name and date of birth. Explanation: If the client does not have an identification band in place, the nurse must first identify the client before administering any medication. A parent should identify an infant or younger child. The nurse can ask an older child his or her name and date of birth or other identifier. There is no need to notify the prescribing health care provider. The nurse should call the admitting department at a later time to obtain a new identification band. Locating another RN to identify the client is not necessary.
The nurse is preparing to administer regular insulin to a nonverbal pediatric client. Which action will the nurse perform prior to administering the medication?
Check the full name and birth date on the client's wristband with the medication administration record. Explanation: When administering medications to a child, the nurse needs to use at minimum two client identifiers that are directly associated with the client and the medication to be given, such as full name, client ID number, and birth date. The nurse will take the medication administration record to the room to perform a "double-identifier" check. A client's identity must be verified with two acceptable identifiers, not just one. There is no need to have another nurse verify or have the parent state the client's information. A room number or a bed number is not an acceptable identifier.
A 6-year-old client is prescribed to receive an oral antibiotic. What should the nurse do before giving the child this medication?
Check to see if the child can swallow pills. Many children do not have enough coordination to swallow tablets or pills until they are 6 or 7 years of age. Children younger than 9 years of age often have difficulty swallowing tablets. This can make getting a child to agree to try an oral medication difficult. The nurse needs to check to see if the child can swallow pills before providing the oral medication. Drinking a glass of water before giving the medication will not determine if the child can swallow an oral medication. Giving the oral medication at the time of the next meal does not necessarily mean that the child will be able to swallow the oral medication. The nurse should not threaten to give the medication with an injection.
A 3-year-old client is being admitted for a tonsillectomy. The nurse notes the client is fussy, crying, and appears nervous about the procedure. Which action by the nurse will be most helpful in alleviating the child's anxiety?
Explain the procedure to the child using dolls and medical equipment. The nurse will explain the procedure to the client using dolls and medical equipment to help the child understand what will happen. This is most appropriate for a client this age. It is appropriate to provide a tour of the operating room, but not show a video due to the child's developmental age. Deep-breathing exercises are not appropriate for a preschool-age client, nor is having another client talk with the child.
The pediatric nurse recognizes that what statement is true regarding medications administered via the intravenous route?
Giving medications through the intravenous route is less traumatic than multiple injections. Explanation: Delivering medications intravenously is actually less traumatic than administering multiple injections. An injection into the fatty tissue between the skin and the muscle is a subcutaneous injection. Medication absorption is quickest via an IV route. When performed properly, all routes of medication administration are safe.
A child with gastroenteritis has been unable to keep oral medication down. What nursing intervention would be appropriate for this client?
Request an intravenous form of the medication. Absorption is the transfer of the drug from its point of entry into the bloodstream, and vomiting and diarrhea interfere with absorption because the drug does not remain in the gastrointestinal tract long enough to be absorbed. Distribution is not affected by vomiting and diarrhea, as it involves movement of the drug through the bloodstream. Metabolism involves conversion of the drug into an active or inactive form, and is unaffected by gastroenteritis. Excretion is the elimination of the drug from the body, usually through the kidneys. This is also unaffected by vomiting and diarrhea.