Ch 35: Key Pediatric Nursing Interventions
The nurse is administering a PRN pain medication to a child. What is the highest priority for the nurse in this situation?
The nurse checks the last time the medication was given.
The nurse is caring for a child who weighs 42 lb (19 kg). The medication prescribed for the child has a therapeutic dosage range of 33 mg/kg/day to 48 mg/kg/day. The medication prescribed is to be given 3 times per day. Which dosage would the nurse identify as being appropriate to administer to this child in one dose?
250 mg
The nursing is teaching parents how to administer a prescribed otic medication for a 2-year-old toddler with otitis media. Which statement will the nurse include in the teaching?
"Be sure the ear drops are at room temperature before administering."
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?
"The client is left-handed and likes to draw; an IV site in his right arm would be best."
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
The nurse is preparing to administer oral ampicillin to a child who weighs 40 kg. The safe dose for children is 50 to 100 mg/kg/day divided in doses administered every 6 hours. What would be the low single safe dose and high single safe dose per day for this child?
500 to 1,000 mg per dose
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 mg
The nurse is administering 2 puffs of an albuterol sulfate inhaler to a 4-year-old. Which side effect would the nurse instruct the parent to most likely expect?
Increased heart rate and restlessness
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?
Allow the child to choose a treat from the drawer.
The nurse enters the room to give a subcutaneous injection of insulin to a 6-year-old child with diabetes. What is the best method of medication administration?
Ask the child where the child would like to have the injection.
The nurse is caring for a child with an ileostomy. What nursing intervention will be included in this child's plan of care?
Check for leakage around the stoma.
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.
The nurse is caring for a child with a nasogastric tube that has been in place for several days. It is time to administer the liquid feeding. What is the priority nursing action?
Check the length of the tube extending from the nose against the measurement recorded when the tube was placed.
The nurse is preparing to administer a PO medication to a 6-year-old in the hospital for an exacerbation of asthma. The nurse notes that the child is due for an oral dose of lansoprazole in 1 hour. What is the most important action for the nurse to take before administering this medication to the client?
Clarify the order, since there is no apparent link between the client's diagnosis and the medication.
A child is receiving intravenous fluids for dehydration. The nurse notes coarse breath sounds and increased pulse and blood pressure. What does the nurse do first?
Discontinue the IV infusion.
A toddler requires 1.5 ml of an antibiotic given intramuscularly (IM). How will the nurse administer this medication?
Divide the dose. Administer 0.75 ml IM in each vastus lateralis.
A nurse is preparing a dose of insulin to give the client. Which action takes priority when preparing and administering this medication?
Double-check the dose with another RN before giving.
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 is teaching a parent how to administer medications to her young child. Which instructions are appropriate? Select all that apply.
Gently restrain the child's head and arms. Have the parent administer the medication. Hold the child against the body with the head raised.
The nurse is assessing a child who is receiving TPN. The nurse determines the TPN bag was hung 24 hours ago. What initial action by the nurse is indicated?
Hang a new bag of TPN
The nurse is assessing a child who is receiving TPN. The nurse determines the TPN bag was hung 24 hours ago. What initial action by the nurse is indicated?
Hang a new bag of TPN.
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.
The parent of a toddler tells the nurse that, when taking medication, the toddler child always makes an awful face and then spits it out. The parent tells the nurse that the medicine tastes extremely bitter, so it is understandable that the toddler does not like it. What would be the best suggestion for this parent?
Mix the medicine with a spoonful of applesauce.
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 child's fluid intake and output.
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.
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?
Obtain radiologic confirmation.
To give eardrops to a 4-year-old child, what would be the best technique to use?
Pull the pinna of the ear up and back.
A preschool-age child who is receiving gastrostomy feedings occasionally vomits following a feeding. When the parent describes the feeding process, what does the nurse note as the likely cause of the vomiting?
The mother does not check gastric residual prior to feedings.
The nurse is caring for a breastfed infant hospitalized for gastroenteritis. Which method can be used to most accurately measure intake?
Weigh the infant before and after feeding and subtract weight.
A medical/surgical nurse has been floated to the pediatric unit. Which action by the float nurse would require the pediatric nurse to intervene?
asking the child his or her name prior to giving medications
The nurse is preparing a subcutaneous insulin injection for a preschooler. How and where should the nurse administer the insulin?
at a 45- to 90-degree angle into the elevated tissue of the upper arm
The nurse is caring for a child with an intravenous device in the hand. Which sign would alert the nurse that infiltration is occurring?
cool, puffy skin
The site most often used when administering a medication using the intradermal route is the:
forearm.
The 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.
A parent must administer a medication in syrup form to a 2-month-old infant. The nurse suggests:
placing the syrup in an medicine syringe.
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.
A nurse is educating the parents how to administer daily oral medication to their 5-year-old boy. Which response indicates a need for further teaching?
"He needs to take his medicine or he will lose a privilege."
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."
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?
"I will pull the outer ear down and back before administering the medication."
The nurse is caring for a 4-year-old child who requires a venipuncture. To prepare the child for the procedure, which explanation is most appropriate?
"The doctor will look at your blood to see why you are sick."
The nurse is providing discharge education to the parents of a 2-year-old who will be taking amoxicillin orally at home. The nurse would include which statement in the teaching?
"Use a dosing cap to measure the dosage."
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."
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."
The nurse is preparing to administer an oral dose of metoclopramide to a 5-year-old child who weighs 40 lb (18.2 kg). The prescription reads metoclopramide 0.8 mg/kg/day to be given in 4 oral doses. How many milligrams of metoclopramide would the nurse give per dose?
3.65 mg per dose
The nurse is caring for a child who weighs 75 lb. The medication ordered for the child has a therapeutic dosage range of 33 mg/kg per day to 48 mg/kg per day. The medication ordered is to be given 4 times per day. Which dosages would be appropriate for the nurse to administer to this child in one dose?
375 mg per dose
A 5-year-old child is to receive long-term IV antibiotics. The mother is concerned about what type of administration method will be used. Which medication administration route may be the most easily accepted?
A peripherally inserted central catheter (PICC) line in an antecubital space
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.
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
A toddler has been prescribed an antibiotic via the intramuscular route. What consideration(s) should the nurse evaluate prior to the administration of this medication? Select all that apply.
muscle site for injection needle size required viscosity of the medication volume to be injected
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."
The nurse is preparing to administer an oral dose of antibiotics to a 10-year-old child who weighs 70 lb (31.75 kg). The prescription reads cephalexin 500 mg orally every 6 hours. The pediatric drug book dosing reads 25 to 100 mg/kg/day in 2 to 4 divided doses. What is the safe range per dose if administering every 6 hours for this client?
199 to 794 mg per dose Explanation: Use the client's weight in kilograms. Calculate the low dose by multiplying 31.75 kg by 25 mg to equal 793.75 mg per day. This must be further divided by 4, the amount of times it is given in a 24-hour period (per day): 795 mg divided by 4 is 198.4, rounded up to 199 mg per dose. The high dose is calculated by multiplying 31.75 kg by 100 mg to equal 3,175 mg per day. This must be further divided by 4 because it is being given every 6 hours: 3,175 mg divided by 4 is 793.75, rounded up to 794 mg per dose.
The nurse is caring for a child who weighs 31 kg. A medication is ordered for this child with a dosage range of 20 to 40 mg per kg of body weight per dose. Which dosage would be appropriate for the nurse to administer to this child in one dose?
1,000 mg per dose
