CHp 22 Peds

How often do behavioral restraints need to be assessed and recorded for a child 7 years old? 1 Every hour 2 Every 2 hours 3 Every 4 hours 4 Every 30 to 45 minutes

1 Behavioral restraints need to be assessed and recorded for a child 7 years old every hour. Assessing every 30 to 45 minutes is not necessary unless there is a problem. Assessing and recording are done every 2 hours for a child 9 to 17 years old and every 4 hours if the person is 18 years or older.

Which method is appropriate when breathing treatments are needed for the toddler? 1 Use of a spacer 2 Tilting head back 3 Place child supine 4 Apply finger pressure to lacrimal punctum

1 Use of a spacer helps a toddler with coordination of breathing and aerosol delivery. Instilling nose drops is associated with the need to tilt the head back. Instilling eye drops is associated with placing the child supine and applying finger pressure to the lacrimal punctum.

Which term describes the adolescent agreeing to cooperate and permit the physician to perform the surgery? 1 Assent 2 Consent 3 Informed consent 4 The parents or legal guardian do not have to consent

1 When an adolescent agrees to cooperate and permit the physician to perform the surgery, the adolescent is giving assent, not informed consent, and must have a parent or guardian sign an informed consent.

Which condition describes a young child seeing the operating room overhead lights and thinking the lights are living things that will suck the life out of people? 1 Animism 2 Autonomy 3 Stranger anxiety 4 Egocentric thought

1 Animism is the belief that inanimate objects are living. Autonomy is associated with independence. Stranger anxiety is the fear of strangers and the anxiety it produces in a person. Egocentric thought is the belief that everything centers around that person.

Which methods are appropriate for postprocedural support of the child? Select all that apply. 1 Positive reinforcement 2 Encouraging expression of feelings 3 Explaining the purpose of the procedure 4 Explaining what to expect during the procedure 5 Explaining the length of time expected to complete the procedure

1,2 Postprocedural support of children includes positive reinforcement and encouragement of expression of feelings. Preprocedural preparation includes explaining what to expect during the procedure, the purpose of the procedure, and the length of time expected to complete the procedure.

Which legal circumstances allow a 16-year-old patient to sign an informed consent for major surgery? Select all that apply. 1 Marriage 2 Pregnancy 3 Military service 4 Emancipated minor 5 Under the age of majority

1,2,3,4 A 16-year-old patient is considered capable of signing an informed consent form under legal circumstances that include being married, being pregnant, being in military service, and being an emancipated minor. The age of majority is when a person is considered to have all the legal rights and responsibilities of an adult. Under that age (unless the patient is an emancipated minor) the patient is not of legal age to sign an informed consent.

Which things promote a positive experience for family members regarding illness and procedures of their child? Select all that apply. 1 Preoperative sedation 2 Parental presence with child 3 Positive preoperative experiences 4 Positive postoperative experiences 5 Photographs of surgical procedures

1,2,3,4 Things that promote a positive experience for family members regarding illness and procedures of their child include positive preoperative and postoperative experiences, parental presence with the child, and preoperative sedation. Photographs of surgical procedures can be distressing.

Which benefits occur when children and parents are well prepared and parents are present during induction of anesthesia? Select all that apply. 1 Reduction of anxiety for some parents 2 Lower doses of postoperative analgesia 3 Shorter discharge time for short procedures 4 Increased need for postoperative pain medications 5 Lower incidence of severe emergence delirium symptoms

1,2,3,5 Benefits that occur when children and parents are well prepared and parents are present during induction of anesthesia include reduction of anxiety for some parents, lower doses of postoperative analgesia, shorter discharge time for short procedures, and lower incidence of severe emergence delirium symptoms. There is a decrease in the need for postoperative pain medications rather than an increased need.

Which nursing actions provide psychological preparation for a child having a procedure? Select all that apply. 1 Establish trust. 2 Provide support. 3 Help the child to develop coping skills. 4 Be honest and explain every detail of the procedure. 5 Encourage parental presence during procedures if possible.

1,2,3,5 Nursing actions that help provide psychological preparation for a child preparing for a procedure include establishing trust, providing support, helping the child develop coping skills, and encouraging the presence of parents during the procedure if possible. It is important to be honest about procedures, but telling every detail may be overwhelming and cause undue stress.

Which nursing interventions help a sick child to eat more? Select all that apply. 1 Serve a "picnic lunch" in a paper bag. 2 Provide finger foods for young children. 3 Praise the child whenever the child does eat. 4 Reward the child by serving meals after any procedures. 5 Serve small, frequent meals rather than three larger meals

1,2,3,5 Nursing interventions that help a sick child eat more include praising the child whenever the child does eat, serving a "picnic lunch" in a paper bag, providing finger foods for young children, and serving small, frequent meals rather than three larger meals. Serving meals after every procedure is not recommended, because food may then be associated with an unpleasant situation.

Which nursing measures are appropriate when establishing trust with children? Select all that apply. 1 Spend time with the child. 2 Be introduced by a caregiver the child trusts 3 Let the first visit with the child be about the child, not the procedure. 4 Have one nurse who causes discomfort and one who gives comfort. 5 Be involved with caregiving activities that give comfort and pleasure.

1,2,3,6 Measures that best establish trust between nurses and children include spending time with the child; being introduced by a caregiver the child trusts; having the first visit with the child be about the child, not the procedure; and being involved with caregiving activities that give comfort and pleasure. It is not optimal for there to be one nurse who causes discomfort and one who gives comfort.

Which nursing actions are appropriate when obtaining a urine specimen from a potty-trained toddler? Select all that apply. 1 Enlisting the parents' help 2 Use familiar words used at home for urination 3 Give an appropriate dosage of a diuretic to facilitate urination 4 Use a potty chair or potty hat on the toilet to facilitate urination 5 Offer liquids that the toddler enjoys and wait 30 minutes until the toddler can void voluntarily if possible

1,2,4,5 Actions by the nurse that would be most appropriate to obtain a urine specimen from a potty-trained toddler include enlisting the parents' help, using familiar words used at home for urination, using a potty chair or potty hat on the toilet to facilitate urination, and, if needed, offering liquids the toddler enjoys and waiting 30 minutes until the toddler can void voluntarily. Giving a diuretic to facilitate urination to obtain a urine specimen from a potty-trained toddler is not appropriate.

Which symptoms are potential causes for increased respiratory rate? Select all that apply. 1 Pain 2 Hypothermia 3 Pain medication 4 Fluid volume excess 5 Elevated temperature

1,2,4,5 Potential causes for increased respiratory rate include pain, hypothermia, fluid volume excess, and elevated temperature. Pain medication will decrease respiratory rate.

Which actions are appropriate to promote cooperation during a procedure? Select all that apply. 1 Reducing any unnecessary delays and interruptions 2 Letting the child know when the procedure is almost over 3 Doing procedures in the playroom to help distract the child 4 Maximizing the number of people present during the procedure 5 Having the same nurse who explains the procedure perform or assist with the procedure

1,2,5 Actions that help promote cooperation during the procedure include reducing any unnecessary delays and interruptions, letting the child know when the procedure is almost over, and having the same nurse who explains the procedure perform or assist with the procedure.

Which nursing technique is appropriate when using play to help with deep breathing? Select all that apply. 1 Blow a pinwheel. 2 Blow bubbles with a bubble blower. 3 Have the toddler use a push-pull toy. 4 Make ice pops using child's favorite juice. 5 Have a blowing contest using ping-pong balls.

1,2,5 Ways the nurse can use play to help with deep breathing include blowing a pinwheel, blowing bubbles with a bubble blower, and having a blowing contest using ping-pong balls. Having a toddler use a push-pull toy is a good play intervention for ambulation but not for deep breathing exercises. Making ice pops using the child's favorite juice is a good intervention for encouraging fluid intake.

Which nonpharmacologic pain-reduction techniques are appropriate when performing venipuncture on the school-age child? Select all that apply. 1 Keep all equipment out of sight until used. 2 Restrain the child with shoulder and ankle straps. 3 Encourage the parents' presence or assistance if they wish. 4 Reassure the child that the body continuously produces blood. 5 Have the child hold the breath while the needle is being inserted

1,3,4, The equipment for venipuncture or arterial puncture such as a needle can be intimidating for a child and thus may cause resistance. It should therefore be kept out of sight until it is used. Children may think that blood removed from their body is a threat to their life, causing them to become anxious and resist. They would be reassured that their body continuously produces blood and it will be replaced right away. The presence of the parents makes the child less anxious and helps the child feel secure. Also, the parents can hold the child during the blood draw. Restraining should be avoided; if necessary, therapeutic holding can be used. Holding the breath should be avoided as it increases pain.

Which are examples of effective distraction that a child might use to cope with a painful procedure? Select all that apply. 1 Counting aloud 2 Tensing muscles 3 Blowing bubbles 4 Listening to music 5 Singing favorite song

1,3,4,5 Effective distraction methods a child might use to cope with a painful procedure include counting aloud, blowing bubbles, listening to music, and singing favorite songs. Tensing muscles contributes to anxiety and pain.

Which activities are encouraged to assist in expression of feelings for children of various ages after a procedure? Select all that apply. 1 Dramatic play 2 Sitting quietly 3 Therapeutic play 4 Throwing activities 5 Acceptable pounding activities

1,3,4,5 Activities that are encouraged to assist in expression of feelings for children of various ages include dramatic play, therapeutic play, throwing activities, and acceptable pounding activities. Sitting quietly is not an activity that promotes expression.

Which infections require droplet precautions? Select all that apply. 1 Mumps 2 Measles 3 Pertussis 4 Varicella 5 Influenza

1,3,5 Infections requiring droplet precautions include mumps, pertussis, and influenza. Measles and varicella require airborne precautions.

Which intramuscular injection sites are appropriate for children? Select all that apply. 1 Deltoid 2 Dorsal gluteal 3 Ventrogluteal 4 Dorsalis pedis 5 Vastus lateralis

1,3,5 Intramuscular sites approved for children include the deltoid, ventrogluteal, and the vastus lateralis. The dorsal gluteal is not an appropriate site, especially for children. The dorsalis pedis is a pulse point on the foot.

Which measures are appropriate when avoiding necrotizing osteochondritis in an infant? Select all that apply. 1 Heel puncture should be no deeper than 2 mm 2 Heel puncture should only be done in cases of heel abscess 3 Heel puncture should be made at the inner aspect of the heel 4 Heel puncture should be made at the outer aspect of the heel 5 Before a heel puncture apply eutectic mixture of local anesthetics (EMLA) cream

1,4 Measures to avoid necrotizing osteochondritis for an infant are to puncture no deeper than 2 mm and that the puncture should be made at the outer aspect (not inner) of the heel. Applying EMLA cream will reduce pain but does not avoid necrotizing oosteochondritis.

Which are postoperative care nursing actions? Select all that apply. 1 Inspecting operative site 2 Obtaining informed consent 3 Removing any loose dressings 4 Assessing skin color and characteristics 5 Notifying physician of any irregularities in the child's condition

1,4,5 Postoperative care nursing actions include inspecting the operative site, assessing skin color and characteristics, and notifying the physician of any irregularities. Dressings need to be reinforced, not removed. Informed consent should be obtained before, not after, surgery.

Which nursing instruction is appropriate when providing more effective teaching for family members giving care in a home setting? 1 Writes brief instructions 2 Shows video recordings 3 Provides research books 4 Uses verbal instructions

2 The nurse shows video recordings, because visual learning is more effective than other forms of communication. Visual learning also helps the parents to understand how to provide care in case they are not fluent in English or are illiterate. Writing brief instructions may not be effective in cases in which many areas of care need to be addressed. Providing research books is helpful if the parents need additional information about the child's illness. Using verbal instructions is inappropriate, because the parents may not be able to remember all the information.

Which statement is appropriate when addressing the principle of family-centered care for a family providing total care for the child while hospitalized before discharge? 1 This is appropriate because families are usually eager to get involved. 2 This is appropriate because it can be beneficial to the transition from hospital to home. 3 This is inappropriate because of legal issues when parents care for their children on hospital property. 4 This is inappropriate because the family will have to assume the care soon enough and this may increase their stress unnecessarily.

2 Having the family care for the child is appropriate, because at least two family members should be comfortable caring for the child before discharge. Caring for the child with the nurse available to answer questions and provide support and guidance will make the transition home for the parents and child easier. The family needs to learn the skills necessary to care for the child at home. Their eagerness is important, but it is not the reason for them to provide total care for their child while the child is still hospitalized. The family members will be able to learn to care for their child with the supervision of nursing staff. Legal issues related to caring for their child in the hospital setting are not relevant. Learning to care for their child before discharge is essential to properly prepare the family to assume the care and minimize their stress level as much as possible.

Which diagnostic tests or procedures require informed consent? Select all that apply. 1 Phlebotomy 2 Minor surgery 3 Lumbar puncture 4 Blood transfusion 5 Removal of a cyst

2 Minor surgery 3 Lumbar puncture 4 Blood transfusion 5 Removal of a cyst Diagnostic tests or procedures that require informed consent include minor surgery, lumbar puncture, removal of a cyst, and blood transfusion. Phlebotomy does not require informed consent.

Which nursing intervention is appropriate for the child who has been hospitalized from postoperative complications and has a decreased appetite and suspected depression? Select all that apply. 1 Restrict dessert if child resists eating. 2 Encourage parents to be present at mealtimes. 3 Provide finger foods as preferred by the child. 4 Involve the child in food selection and preparation. 5 Force the child to eat to maintain the level of nutrition.

2 , 3, 4 The nurse can give the child the finger foods, which are favorites of most children. Children often feel depressed due to separation from their parents. Asking the parents to be present at mealtimes is helpful for the child. Whenever possible, the nurse can involve the child in food selection and food preparation and that way the nurse comes to know the child's food habits and favorite foods. This will help feed the child with less resistance. The child should never be punished for not eating. The child may become more resistant if the child feels punished. Likewise, forcing the child to eat may intensify the problem.

What do play activities provide for a 9-year-old child about to have a planned surgery? Select all that apply. 1 Provide distraction while performing the procedure 2 Encourage expression of feelings in a constructive way 3 Help as a teaching method to achieve a therapeutic goal 4 Have a soothing effect if the procedure is done in a play area 5 Put the child in a position of control to resist any unwanted procedure

2,3 Play activities help to familiarize the child with hospital items so that it is less intimidating for the child when the procedure is performed. Nursing care would include play activities as a teaching method to achieve a therapeutic goal and to express feelings. Play activities before a planned surgery can encourage children to vent their anger and frustration in a constructive way. Distractions provided at the time of a procedure are not necessarily play activities; but other coping strategies like singing favorite songs, listening to music with a headset, or counting aloud can be done during a painful procedure. The procedure would always be performed in a procedure room where all the facilities are available rather than in a play area. Play activities place the child in a position of control in contrast to the real situation of helplessness. The nonthreatening communication clarifies misconceptions in an older child and thus helps to ease resistance.

Which nonthreatening words or phrases are appropriate when explaining medical procedures and equipment? Select all that apply. 1 "Stool" instead of "poop" 2 "Make better" instead of "fix" 3 "Puffiness" instead of "edema" 4 "Sample" instead of "specimen" 5 "Bee sting" instead of "medicine under the skin

2,3,4 Nonthreatening words or phrases that are preferred when explaining medical procedures and equipment include the use of "make better" instead of "fix," the use of "puffiness" instead of "edema," and the use of "sample" instead of "specimen". The use of "stool" instead of "poop" and the use of "bee sting" instead of "medicine under the skin" are not appropriate, because they are more threatening or scary for a child. p. 683

Which nursing intervention is appropriate for the child who has been hospitalized from postoperative complications and has a decreased appetite and suspected depression? Select all that apply. 1 Restrict dessert if child resists eating. 2 Encourage parents to be present at mealtimes. 3 Provide finger foods as preferred by the child. 4 Involve the child in food selection and preparation. 5 Force the child to eat to maintain the level of nutrition

2,3,4 The nurse can give the child the finger foods, which are favorites of most children. Children often feel depressed due to separation from their parents. Asking the parents to be present at mealtimes is helpful for the child. Whenever possible, the nurse can involve the child in food selection and food preparation and that way the nurse comes to know the child's food habits and favorite foods. This will help feed the child with less resistance. The child should never be punished for not eating. The child may become more resistant if the child feels punished. Likewise, forcing the child to eat may intensify the problem.

Which method is appropriate when preparing an older teen for surgery? Select all that apply. 1 Be aware of animism tendencies. 2 Discuss why the procedure is necessary. 3 Be open to discuss the teen's fear of death. 4 Discuss the scars associated with the surgery. 5 State directly that surgery is never a form of punishment.

2,3,4 The nurse prepares the teen for surgery by discussing why the procedure is necessary, being open to discussing the teen's fear of death, and discussing the scars associated with the surgery. A teen does not usually have animist tendencies and will not view the surgery as form of punishment.

Which words are appropriate to use instead of pain? Select all that apply. 1 Shot 2 Sore 3 "Owie" 4 Scratchy 5 "Boo-boo" 6 Discomfort

2,3,4,5,6 In a pediatric patient, words recommended to use instead of "pain" include "sore," "owie," "scratchy," "boo-boo," and "discomfort." The word "shot" is very intimidating and threatening to a child.

Which play activities encourage motion or use of extremities? Select all that apply. 1 Blowing a pinwheel 2 Providing clay to mold with fingers 3 Having the toddler use a push-pull toy 4 Making ice pops using child's favorite juice 5 Throwing wadded-up paper into a wastebasket

2,3,5 Activities that would encourage motion or the use of extremities include providing clay to mold with fingers, having the toddler use a push-pull toy, and throwing wadded-up paper into a wastebasket. Blowing a pinwheel would be used for deep breathing, and making ice pops using the child's favorite juice would assist with fluid intake.

Which nursing action is appropriate when administrating an intramuscular vaccination to a 3-year-old child? Select all that apply. 1 Usually 0.5 ml is the maximum volume to be injected. 2 Repeated use of a single site can result in muscle fibrosis. 3 Deltoid muscle injection results in less pain and fewer side effects. 4 Aspiration is necessary during intramuscular vaccine administration. 5 The vastus lateralis site is easily accessible and tolerates larger quantities of fluid.

2,3,5 Repeated use of a single site for intramuscular injections would be avoided, because it results in muscle fibrosis and subsequently muscle contracture. The deltoid muscle is a preferable site for intramuscular vaccine injection because it is less painful and has fewer local side effects compared to the vastus lateralis. The vastus lateralis is the preferred site for intramuscular immunization, as recommended by the Centers for Disease Control and Prevention, the World Health Organization, and the American Academy of Pediatrics. It is easily accessible and has a large well-developed muscle that can tolerate larger quantities of fluid. Usually a maximum volume of 1 ml can be injected for older infants and young children. Aspiration during intramuscular injection of vaccines would be avoided.

Which activities are appropriate to help a child cope when the child needs to have injections? Select all that apply. 1 Have the child count to 10 or 15 before the injection. 2 Let the child give an injection to a doll or stuffed animal. 3 Let the child give an injection to the nurse before getting their injection. 4 Draw a magic circle on the area before injection and put a smiley face in the circle. 5 If the child needs multiple injections have the child make a progress poster and give rewards as the child makes progress.

2,4,5 Activities that can help a child cope when receiving injections include letting the child give an injection to a doll or stuffed animal, drawing a magic circle on the area before the injection and putting a smiley face in the circle, and, if the child needs multiple injections, having the child make a progress poster and giving rewards as the child makes progress. The child would count during, not before, the injection. It is not appropriate for the child to give the nurse an injection before getting an injection.

Which procedures or diagnostic tests require informed consent? Select all that apply. 1 Chest x-ray 2 Paracentesis 3 Cardiac Electrocardiogram (ECG) 4 Bronchoscopy 5 Cardiac catheterization

2,4,5 Procedures or diagnostic tests that require informed consent include paracentesis, bronchoscopy, and cardiac catheterization. A chest x-ray and cardiac ECG do not have an element of risk associated with them, so an informed consent is not necessary.

Which measuring device for medicine is appropriate when teaching the parents of a 2-year-old child? 1 Molded plastic cups 2 Dropper with grading 3 Plastic calibrated oral syringe 4 Paper cup with 5-ml indicator

3 A plastic disposable calibrated oral syringe is the most accurate means for measuring small amounts of medication. It is also convenient to transport and administer medicine through it. A dropper is unreliable because the volume of a drop varies according to the viscosity of the liquid measured. Molded plastic cups with measuring lines are given with over-the-counter medications, but one study showed that the vast majority of families could not measure medication accurately with it. Paper cups are unsuitable for liquid medications because they can crumple and collapse easily.

Which developmental stage is appropriate to praise a child for helping and attempting to cooperate? 1 Trust 2 Identity 3 Initiative 4 Autonomy

3 When a nurse praises a child for helping and attempting to cooperate, the developmental stage being reinforced is initiative. Trust is associated with infancy and is reinforced by supplying basic needs. Autonomy encourages independence, and identify is related to self-concept.

Which nursing intervention is appropriate when teaching a child about analgesic medication? 1 Using oral syringes 2 Written instructions 3 Organizing pillboxes 4 Assigning color-coded medication bottles

4 Children may not be able to understand and follow the instructions provided by the nurse. Color-coded medication bottles may help them to understand the medication regimen, because verbal communication alone may not help in preventing noncompliance. Preschoolers have limited cognitive ability. Therefore, written instructions, oral syringes, and pillboxes may not help with medication compliance in preschoolers.

Which impaired function is appropriate to discuss when teaching the parents of a child receiving enteral therapy? 1 Digestion 2 Urination 3 Breathing 4 Swallowing

4 Enteral therapy refers to the process of providing nutrition through the gastrointestinal system. Postoperative patients may experience difficulty in swallowing. Enteral therapy is used for meeting their nutritional needs. Enteral therapy is not indicated for postoperative patients with impaired breathing, impaired urination, or impaired digestion. These patients are able to eat and swallow properly and may not need enteral therapy.

The nurse is caring for a Chinese child with a peripheral nerve injury. The nurse is teaching the parents about exercises during discharge. Which nursing intervention is appropriate to provide when teaching Chinese parents about exercises during discharge? 1 Audio tapes about the exercises 2 Verbal instructions for the exercises 3 Written instructions for the exercises 4 Video recordings demonstrating the exercises

4 Nurses would be proactive in providing effective home care strategies during the predischarge assessment. It is helpful if family members involved in patient care in the hospital are also the caregivers at home. Video recordings are the supportive devices that best provide information about home care strategies for non-English speaking communities such as Chinese people, because they provide clear information. Verbal instructions, audio tapes, and written instructions might not help non-English speaking parents.

5. Children and adolescents should be prepared for procedures according to their level of development and understanding. Which interventions by the nurse would be helpful? Select all that apply. A. Explain procedure in relation to what the child will see, hear, taste, smell, and feel. B. Although older children may associate objects, places, or persons with prior painful experiences, infants will not have a memory of past experiences. C. For school-age children, preparation can take several days in advance of the procedure to allow for processing of information. D. Provide privacy; describe how the body will be covered and what will be exposed. E. Allowing adolescents to talk with other adolescents who have had the same procedure may increase their level of anxiety and is not recommended.

A. Explain procedure in relation to what the child will see, hear, taste, smell, and feel. D. Provide privacy; describe how the body will be covered and what will be exposed.

2. During hospitalization, there may be a reason to use restraints. Protocol for using restraints may include which of the following? Select all that apply. A. One finger breadth should be left between the skin and the device, and knots should be tied to allow for quick release. B. Elbow restraints fashioned from a variety of materials function well when a child's hands must be kept from his or her face—for example, after cleft lip or palate surgery. C. A papoose board with straps or a mummy wrap effectively controls the child's movements when an infant or small child requires short-term restraint for examination or treatment that involves the head and neck. D. Before initiating a behavioral restraint, the nurse should assess the patient's mental, behavioral, and physical status to determine the cause for the child's potentially harmful behavior. E. Unless state law is more restrictive, behavioral restraints for children must be reordered every 2 hours for children under 9 years of age and every 3 hours for children 9 to 17 years old.

A. One finger breadth should be left between the skin and the device, and knots should be tied to allow for quick release. B. Elbow restraints fashioned from a variety of materials function well when a child's hands must be kept from his or her face—for example, after cleft lip or palate surgery. C. A papoose board with straps or a mummy wrap effectively controls the child's movements when an infant or small child requires short-term restraint for examination or treatment that involves the head and neck. D. Before initiating a behavioral restraint, the nurse should assess the patient's mental, behavioral, and physical status to determine the cause for the child's potentially harmful behavior.

1. When administering a medication to a child, the nurse knows that: A. The most accurate means for measuring small amounts of medication is the plastic disposable calibrated oral syringe. B. A teaspoon is often the unit of measurement for pediatric medication and is especially helpful when working with families. C. Using a dropper is also acceptable, remembering that thick fluids are easier to measure than viscous fluids. D. For more exact measuring, emptying dropper contents into a medicine cup can be helpful.

A. The most accurate means for measuring small amounts of medication is the plastic disposable calibrated oral syringe.

4. When obtaining a heelstick for laboratory results: A. The heelstick is performed because it is less invasive and less painful than a venipuncture. B. Breastfeeding during a neonatal heelstick is effective in reducing pain and has been found to be more effective than sucrose in some studies. C. Although safe for use in preterm infants when applied correctly, EMLA has been found to be much more effective than placebo in preventing pain during heel lancing. D. To avoid osteochondritis (underlying calcaneus bone, infection, and abscess of the heel), the puncture should be no deeper than 1 mm and should be made at the inner aspect of the heel.

B. Breastfeeding during a neonatal heelstick is effective in reducing pain and has been found to be more effective than sucrose in some studies.

3. You are working with a new nurse to give an intramuscular injection. Which principles do you want to include when doing this teaching? Select all that apply. A. Usually 2 ml is the maximum volume that should be administered in a single site to small children and older infants. B. New evidence suggests that immunizations at the ventrogluteal site have been found to have fewer local reactions and fever. C. Distraction and prevention of unexpected movement may be more easily achieved by placing the child supine on a parent's lap for ventrogluteal site use. D. The deltoid muscle advantages are less pain and fewer side effects from the injectate compared with the vastus lateralis. E. Aspiration during intramuscular vaccine administration is always recommended.

B. New evidence suggests that immunizations at the ventrogluteal site have been found to have fewer local reactions and fever. C. Distraction and prevention of unexpected movement may be more easily achieved by placing the child supine on a parent's lap for ventrogluteal site use. D. The deltoid muscle advantages are less pain and fewer side effects from the injectate compared with the vastus lateralis.