FINAL 9
Several types of long-term central venous access devices are used. What is a benefit of using an implanted port (e.g., Port-a-Cath)?
The patient does not need to limit regular physical activity, including swimming
The nurse determines that a child's intravenous infusion has infiltrated. The infused solution is a vesicant. What is the most appropriate nursing action?
End the infusion and notify the practitioner.
Nurses should be alert for increased fluid requirements in which circumstance
Fever
A toddler sustains a minor burn on the hand from hot coffee. What is the first action in treating this burn?
Hold the hand under cool running water
To facilitate the administration of an oral medication to a preschool-age child, what action should the nurse take?
Set limits about the need to take medication and offer praise immediately after the task is accomplished.
What is the most immediate threat to life in children with thermal injuries
Shock
What is an effective strategy to reduce the stress of burn dressing procedures
Involve the child and give choices as feasible.
The nurse suspects fluid overload in an infant receiving intravenous fluids. What clinical manifestation is suggestive of water intoxication?
Irritability and seizures
The nurse has just collected blood by venipuncture in the antecubital fossa. What should the nurse do next?
Keep the child's arm extended and apply pressure to the site for a few minutes.
What is a strategy used to minimize scarring with burn injury in a child
Limitation of period without pressure to areas of scarring
When checking the intravenous (IV) site on a child, the nurse should take which action?
Look at the site while palpating the area.
What physiologic state(s) produces the clinical manifestations of nervous system stimulation and excitement, such as overexcitability, nervousness, and tetany
Metabolic and respiratory alkalosis
The nurse is caring for an 18-month-old child with rotavirus. What clinical manifestations should the nurse expect to observe?
Mild fever and vomiting followed by onset of watery stools
What is the purpose of a high-protein diet for a child with major burns
Minimize protein breakdown
What clinical manifestation(s) is associated with calcium depletion (hypocalcemia)?
Neuromuscular irritability
What is the nursing action related to the applying of biologic or synthetic skin coverings for a child with partial-thickness burns of both legs?
Observe wounds for signs of infection
An appropriate method for administering oral medications that are bitter to an infant or small child should be to mix them with which?
One teaspoon of something sweet-tasting such as jam
A 7-year-old child with acute diarrhea has been rehydrated with oral rehydration solution (ORS). The nurse should recommend that the child's diet be advanced to what kind of diet?
Regular diet
A child, age 7 years, has a fever associated with a viral illness. She is being cared for at home. What is the principal reason for treating fever in this child?
Relief of discomfort
What flush solution is recommended for intravenous catheters larger than 24 gauge?
Saline
A nurse must do a venipuncture on a 6-year-old child. What consideration is important in providing atraumatic care?
Show the child the equipment to be used before the procedure.
The nurse needs to start an intravenous (IV) line on an 8-year-old child to begin administering intravenous antibiotics. The child starts to cry and tells the nurse, "Do it later, okay?" What action should the nurse take?
Start the IV line and then allow for expression of feelings.
Ongoing fluid losses can overwhelm the child's ability to compensate, resulting in shock. What early clinical sign precedes shock?
Tachycardia
A 1-month-old infant is admitted to the hospital. The infant's mother is 17 years old and single and lives with her parents. Who signs the informed consent for the 1-month-old infant?
The infant's mother
At which age should a nurse keep teaching time short (5 minutes)?
Toddler
What finding is the most reliable guide to the adequacy of fluid replacement for a small child with burns?
Urinary output of 1 to 2 ml/kg of body weight/hr
The nurse on a pediatric unit is writing guidelines for age-specific preparation of children for procedures based on developmental characteristics. What guideline is accurate?
Use simple diagrams of anatomy and physiology to explain a procedure to a school-age child.
What consideration is important for the nurse when changing dressings and applying topical medication to a child's abdomen and leg burns?
Wash hands and forearms before and after dressing change
An infant is brought to the emergency department with the following clinical manifestations: poor skin turgor, weight loss, lethargy, tachycardia, and tachypnea. This is suggestive of which situation?
Water depletion
What clinical manifestation(s) should the nurse expect to see as shock progresses in a child and becomes decompensated shock?
Confusion and somnolence
What is the required number of milliliters of fluid needed per day for a 14-kg child?
1200
The nurse is administering an IM injection into a vastus lateralis muscle of a 6-month-old infant. What should the length of the needle and amount to be given be?
5/8 to 1 inch; 0.5 to 1.0 ml
What amount of fluid loss occurs with moderate dehydration?
50 to 90 ml/kg
The practitioner has ordered a liquid oral antibiotic for a toddler with otitis media. The prescription reads 1 1/2 tsp four times per day. What should the nurse consider in teaching the mother how to give the medicine?
A hollow-handled medication spoon is advisable, and the medication should be equally spaced while the child is awake.
What condition is often associated with severe diarrhea?
Metabolic acidosis
What is an approximate method of estimating output for a child who is not toilet trained?
Weigh diapers after each void.
A child has a central venous access device for intravenous (IV) fluid administration. A blood sample is needed for a complete blood count, hemogram, and electrolytes. What is the appropriate procedure to implement for this blood sample?
Withdraw a blood sample equal to the amount of fluid in the device, discard, and then withdraw the sample needed.
The presence of which pair of factors is a good predictor of a fluid deficit of at least 5% in an infant?
Dry mucous membranes and generally ill appearance
Clinical manifestations of sodium excess (hypernatremia) include which signs or symptoms?
Dry, sticky mucous membranes
What type of diarrhea is associated with an inflammation of the mucosa and submucosa in the ileum and colon caused by infectious agents?
Dysenteric
Hydrotherapy is required to treat a child with extensive partial-thickness burn wounds. What is the purpose of hydrotherapy?
Débride the wounds
A school-age child with diarrhea has been rehydrated. The nurse is discussing the child's diet with the family. What food or beverage should be tolerated best?
Easily digested foods
The nurse is teaching the family of a child with a long-term central venous access device about signs and symptoms of bacteremia. What finding indicates the presence of bacteremia?
Fever and general malaise
Physiologically, the child compensates for fluid volume losses by which mechanism?
Fluid shift from interstitial space to intravascular space
What is an advantage of the ventrogluteal muscle as an injection site in young children?
Free of significant nerves and vascular structures
A school-age child with acute diarrhea and mild dehydration is being given oral rehydration solutions (ORS). The child's mother calls the clinic nurse because he is also occasionally vomiting. The nurse should recommend which intervention?
Continue to give ORS frequently in small amounts.
The nurse is selecting a site to begin an intravenous infusion on a 2-year-old child. The superficial veins on his hand and arm are not readily visible. What intervention should increase the visibility of these veins?
Gently tap over the site.
What organism is a parasite that causes acute diarrhea?
Giardia lamblia
preschool child needs a dressing change. To prepare the child, what strategy should the nurse implement?
Give choices when possible but avoid delay
Guidelines for intramuscular administration of medication in school-age children include what standard?
Insert needle quickly, using a dartlike motion.
The nurse is teaching a group of female adolescents about toxic shock syndrome and the use of tampons. What statement by a participant indicates a need for additional teaching?
"I can use a superabsorbent tampon for more than 6 hours."
The nurse is teaching a parent of a 10-year-old child who will be discharged with a venous access device (VAD). What statement by the parent indicates a correct understanding of the teaching?
"I should apply pressure to the entry site to the vein, not the exit site, if the VAD is accidentally removed."
An 11-month-old hospitalized boy is restrained because he is receiving intravenous (IV) fluids. His grandmother has come to stay with him for the afternoon and asks the nurse if the restraints can be removed. What nurse's response is best?
"That is fine as long as you are with him."
What is a systemic response to severe burns in a child?
Abrupt drop in cardiac output
A child is admitted with extensive burns. The nurse notes burns on the child's lips and singed nasal hairs. The nurse should suspect what condition in the child
An inhalation injury
What type of shock is characterized by a hypersensitivity reaction causing massive vasodilation and capillary leaks, which may occur with drug or latex allergy
Anaphylactic shock
What sign is one of the first to indicate overwhelming sepsis in a child with burn injuries?
Disorientation
What substance is released from the posterior pituitary gland and promotes water retention in the renal system?
Antidiuretic hormone (ADH)
A critically ill child has hyperthermia. The parents ask the nurse to give an antipyretic such as acetaminophen. How should the nurse respond to the parents?
Antipyretics are of no value in treating hyperthermia.
Frequent urine tests for specific gravity are required on a 6-month-old infant. What method is the most appropriate way to collect small amounts of urine for these tests?
Aspirate urine from cotton balls inside the diaper with a syringe without a needle.
What is the best method to verify the placement of a nasogastric tube before each use?
Aspiration of stomach contents
The nurse gives an injection in a patient's room. How should the nurse dispose of the needle?
Dispose of the syringe and needle in a rigid, puncture-resistant container in the patient's room.
What is the most frequent cause of hypovolemic shock in children?
Blood loss
A laboratory technician is performing a blood draw on a toddler. The toddler is holding still but crying loudly. The nurse should take which action?
Do nothing. It's Okay for a child to cry during a painful procedure.
When caring for a child with an intravenous (IV) infusion, what is an appropriate nursing action?
Check the insertion site frequently for signs of infiltration
The nurse is preparing to administer a liquid medication by a nasogastric feeding tube. What is the first thing the nurse should do?
Check the pH of the gastric aspirate
The nurse is preparing to give acetaminophen (Tylenol) to a child who has a fever. What nursing action is appropriate?
Check to be sure the Tylenol dose does not exceed 15 mg/kg.
A child who has cystic fibrosis is admitted to the pediatric unit with methicillin-resistant Staphylococcus aureus (MRSA) infection. The nurse recognizes that in addition to a private room, the child is placed on what precautions?
Contact
What laboratory finding should the nurse expect in a child with an excess of water?
Decreased hematocrit
A 2-year-old child has to receive Rocephin IM injections every 12 hours. What nursing intervention should be implemented for the child?
Hold the child while rocking in a chair after each injection.
Prevention of burn injury is important anticipatory guidance. In the infant and toddler period, which mode is the most common cause of burn?
Hot liquids in the kitchen
What type of dehydration occurs when the electrolyte deficit exceeds the water deficit?
Hypotonic dehydration
What factor predisposes an infant to fluid imbalances?
Immature kidney functioning
When teaching a mother how to administer eye drops, where should the nurse tell her to place them
In the conjunctival sac when the lower eyelid is pulled down
What explains physiologically the edema formation that occurs with burns
Increased capillary permeability
After the acute stage and during the healing process, what is the primary complication from burn injury?
Infection
Parents are being taught how to feed their infant using a newly placed gastrostomy tube (G-tube). What is essential information for the parents to receive?
Position the infant on the right side during and after the feeding.
A 2-year-old child is being admitted to the hospital for possible bacterial meningitis. When preparing for a lumbar puncture, what should the nurse do?
Prepare the child for conscious sedation being used for the procedure.
What is a priority intervention for an infant with a temporary colostomy for Hirschsprung disease?
Protecting the skin around the colostomy
Fentanyl and midazolam (Versed) are given before débridement of a child's burn wounds. What is the purpose of using these medications?
Provide pain relief
The nurse suspects shock in a child 1 day after surgery. What should be the initial nursing action?
Provide supplemental oxygen.
