Chapter 38: Nursing Care of a Family when a Child Needs Medication Administration or Intravenous Therapy

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."

A toddler is prescribed amoxicillin for bilateral otitis media. The parent reports that the toddler refuses to take the oral medication. The nurse knows that more education is needed when the parent makes which statement?

"I will shake the medication well, and draw up the medication to the top of the syringe. My spouse and I will hold our toddelr down and force the medication down his throat."

A nurse is preparing to start an IV for a 3-year-old child. Which nursing actions are appropriate for a child this age? Select all that apply.

Explain the procedure to the child. Take the child to the treatment room. Have another nurse hold the child still. Give the child a sticker when finished.

The nurse educator is teaching the class of nurses about infusion control in children. The nurse knows that more education is needed when the student nurse states:

"No special pumps are needed for the pediatric patient; I can use the same one that we use with adult patients."

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."

Before giving an injection to a young child, the nurse would make which of the following statements about the pain the child will feel?

"You can yell or scream when the needle is inserted if you want."

A 12-month-old child weighing 11 lb has an order for gentamycin sulfate 13 mg IM q 36 hour. The pharmacy has 20 mg/2 mL on hand. How may milliliters would the infant receive, and what is the best site for the injection?

1.3 mL; vastus lateralis

A child who weighs 22 lb (10 kg) is to receive a blood transfusion. How many milliliters of blood should the nurse expect to transfuse in an hour?

100

A nurse is caring for a child who requires intravenous maintenance fluid. The child weighs 30 kg. Calculate the child's daily maintenance fluid requirement in milliliters. Record your answer using a whole number.

1700

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

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 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.

The nurse is administering a liquid medication to a 3-year-old using an oral syringe. Which action would be most appropriate?

Allow the child time to swallow the medication in between amounts.

A child is prescribed multiple intravenous medications. Which nursing action demonstrates the best practice to maintain medication safety?

Flush the intravenous line between each medication.

The nurse is caring for a pediatric client who requires vitamins, minerals, lipids and amino acids through the circulatory system instead of the gastrointestinal tract. Which type of intravenous therapy is anticipated for long-term therapy?

Central venous catheter infusions

A health care provider has prescribed hydroxyurea 650 mg for a child diagnosed with sickle cell anemia. The child weighs 65 lb (29.5 kg). The normal recommended dose is 20 mg/kg/day. What action should the nurse take?

Contact the health care provider to lower the dose.

A nursing instructor is teaching students about intravenous (IV) fluid administration to infants and children. Which type of fluid does the nurse say must be administered to children and infants to prevent water intoxication?

Isotonic

A nurse knows that a child's metabolism is faster than an adult's and, therefore, certain medications for children need to be administered in which way?

More frequently

The nurse is caring for a preschooler who has become dehydrated due to an intestinal virus. Which approach to replace the fluid loss is initially anticipated?

Oral rehydration

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

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.

An order for an intramuscular medication has been ordered for a 4-year-old. The nurse finds the child in the playroom with his caregiver. Which action by the nurse would be the best procedure to follow when administering this medication?

Take him to a separate treatment room to give him his injection. Praise his cooperation even if he cries. Take him back to the playroom. Complete all required documentation.

A 6-month-old child has developed skin irritation due to an allergic reaction. He has been prescribed a topical skin ointment. The nurse will consider which of the following before administering the drug?

That the infant's skin has greater permeability than that of an adult

A nurse is assigned to a pediatric unit for an 8 hour shift. When administering medications to a pediatric patient rather than an adult, which does the nurse consider? (Select all that apply.)

The child's developmental level The child's weight The child's developing body systems The child's smaller size

The nurse is preparing to administer regular insulin to a child following lunch. Which finding will cause the nurse to question administering the medication?

The client received insulin aspart 2 hours ago.

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.

The nurse is instructing a parent on administering ear drops to a 6-year-old. Which parental action demonstrates an understanding of teaching?

The parent has the child sit down and pulls the pinna upward and back

A nursing student is administering medications to her client, Tommy, on a pediatric floor. What action by the student demonstrates a need for further instruction?

The student asks the client if he is Tommy before giving the medication.

The nurse is determining a pediatric dosage of medication using the West nomogram for estimating body surface area (BSA). Which two known factors are on the left and the right scales?

Use the client's height and weight

Using the West nomogram scale, the nurse needs to calculate the safe dosage of a medication for a child. The child is 50 inches tall and weighs 76 lb. The normal dosage of the medication for an adult is 300 mg. Which of the following is the correct way to use the West nomogram scale?

Use the scale to locate the child's height and weight. Use a straight edge to align these numbers with the scale indicating the surface area, divide that by the average adult body surface area, and multiply the resulting number by the adult dose.

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.

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

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.

The clinical nurse educator who oversees the emergency department in a children's hospital has launched an awareness program aimed at reducing drug errors. What measure addresses the most common cause of incorrect doses in the care of infants and children?

Having nurses check their math calculations with a colleague before administering a drug

A nurse who provides care on a pediatric unit of a hospital is aware that the potential for harm as a result of drug errors is higher among infants and children than adults. This fact is primarily due to

Immature liver and kidney function in infants and children.

What is a fundamental rationale for the administration of intravenous therapy? Select all that apply.

To maintain fluid and electrolyte balance To have access to the intravenous route for testing Medications and nutrients can be infused through the line.

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.

The nurse has administered a medication to a child. When documenting the dosage given, the nurse realizes that an incorrect dose has been administered. The nurse has taken the child's vital signs, and they are within normal range. The child does not appear to be in any distress and is acting normally. Which of the following would be the next action for the nurse to take?

Follow the facility policy regarding medication errors.

The nurse at a camp for children with asthma is teaching these children about the medications they are taking and how to properly take them. The nurse recognizes that many medications used on a daily basis for the treatment of asthma are given by which method?

Using a nebulizer

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.