NUR 232 Chapter 39

The nurse is caring for a child who is prone to pressure ulcers. What interventions by the nurse would ensure appropriate skin care? Select all that apply. 1. Use minimum tape. 2. Alternate electrode sites. 3. Always keep the skin wet. 4. Massage reddened bony prominences. 5. Use non-alcohol-based moisturizing agents.

1, 2, 5 For appropriate skin care, the nurse alternates electrode and probe placement sites and thoroughly assesses underlying skin typically every 8 to 24 hours. This is done to avoid irritation. Minimum amount of tape and adhesives is used to minimize damage. The nurse applies non-alcohol-based moisturizing agents after cleansing to retain moisture and rehydrate the skin. The nurse should not massage reddened bony prominences because this can cause deep tissue damage; pressure relief to those areas should instead be provided. The nurse should keep skin free of excess moisture.

What is the best explanation for why pulse oximetry is used on young children? 1.It is noninvasive. 2. It is better than capnography. 3. It provides intermittent measurements of O2. 4. It is more accurate than arterial blood gases.

1.It is noninvasive. Pulse oximetry is a noninvasive method to determine oxygen saturation. Capnography measures carbon dioxide exhalation. It does not reflect oxygen perfusion. Pulse oximetry is less invasive and easier to test than arterial blood gases. Pulse oximetry provides continuous or intermittent measurements of oxygen saturation.

A 9-year-old patient is scheduled for a surgical procedure next week. What teachings will the nurse include to ensure the patient's assent? Select all that apply. 1. Assess patient understanding. 2. Tell the patient what can be expected. 3. Inform the patient how consent is obtained. 4. Solicit an expression of the patient's willingness. 5. Inform the patient about the nature of the condition.

1, 2, 4, 5 Assent of the patient should include four key teachings. The nurse should help the patient achieve a developmentally appropriate awareness of the nature of their condition. The nurse should tell the patient what can be expected. The nurse should also make a clinical assessment of the patient's understanding, and solicit an expression of the patient's willingness to accept the proposed procedure. Such measures help reduce anxiety in the patient and are important for their assent. Information about the legal procedures of obtaining consent is not related to the surgical procedure and will not be as helpful in reducing anxiety.

What interventions does the nurse take to ensure appropriate skin care for a child on a ventilator? Select all that apply. 1. Place gel pillows under pressure points. 2. Reposition the patient in bed three times a week. 3. Keep the bedding smooth and free from wrinkles. 4. Keep tubes and wires from lying under the bedding. 5. Apply a hydrocolloid barrier to protect the facial cheeks.

1, 3, 4, 5 To maintain skin integrity in the mechanically ventilated patient, the nurse applies a hydrocolloid barrier to protect the facial cheeks. The nurse places gel pillows under pressure points such as occiput, heels, elbows, and shoulders to relieve pressure. No tubes, lines, wires, or wrinkles should be allowed in bedding under the patient, as their presence is a risk for pressure ulcer formation. The nurse repositions the patient at least every 2 hours as the patient's condition tolerates.

The relative of a child receiving oxygen therapy brings the child a remote-controlled airplane as a gift. What safety risk does the toy present to the patient? 1. The toy can cause fire. 2. The toy may distract the child. 3. The toy may cause suffocation. 4. The toy may have toxic lead paint.

1. The toy can cause fire. Electrical or friction toys are not safe because sparks can cause oxygen to ignite. Bags made of plastic or other material are more likely to cause suffocation. Toxic lead paint is usually a concern for toys from unknown manufacturers. Distraction can be an advantage for the child because it is likely to bring some joy and solace.

The nurse is removing the tape of an intravenous catheter in a child. What is the most appropriate instruction given by the nurse? 1. "Let's remove the tape together." 2. "You are the bravest kid in the world." 3. "This will cause just a little bit of pain." 4. "Stay calm while I remove the catheter."

1. "Let's remove the tape together." When it is time to discontinue an intravenous infusion, many children are distressed by the thought of catheter removal. Encouraging children to remove or help remove the tape from the site provides them with a measure of control and often fosters their cooperation. The nurse should not remove the tape without first asking the child for cooperation, so asking he child to remain calm and then remove the catheter is inappropriate. The nurse should not use the word pain; saying that it would cause discomfort is more appropriate. Telling children that they are bravest in the world may actually make them fear removal of the catheter as children are used to such statements during distress.

The nursing instructor is teaching a group of students about the use of enemas in children. The instructor says, "We usually do not use Fleet enemas for children." What statement by the student indicates a need for additional teaching? 1. "They are hypotonic." 2. "They can cause diarrhea." 3. "They may cause hypernatremia." 4. "They can cause metabolic acidosis."

1. "They are hypotonic." Plain water is hypotonic, not the Fleet enema. The Fleet enema is not advised for children because of the harsh action of sodium biphosphate and sodium phosphate. The osmotic effect of the Fleet enema may produce diarrhea, which can lead to metabolic acidosis. Other potential complications of using the enema are hyperphosphatemia and hypernatremia.

Which antipyretic is associated with Reye syndrome in children? 1. Aspirin (Bayer) 2. Ibuprofen (Advil) 3. Norfloxacin (Noroxin) 4. Acetaminophen (Tylenol)

1. Aspirin (Bayer) Aspirin should not be given to children because of its association in children with influenza virus or chickenpox and Reye syndrome. Other antipyretics include acetaminophen (Tylenol), and nonsteroidal anti-inflammatory drugs (NSAIDs). Acetaminophen (Tylenol) is the preferred drug. One nonprescription NSAID, ibuprofen (Advil), is approved for fever reduction in children as young as 6 months of age. Norfloxacin (Noroxin) is an antibiotic and is usually prescribed for bacterial infection of the gastrointestinal system.

When is bronchial (postural) drainage generally performed? 1. Before meals and at bedtime 2. Immediately before all aerosol therapy 3. Immediately on arising and at bedtime 4. Thirty minutes after meals and at bedtime

1. Before meals and at bedtime. The most effective time for bronchial drainage is before meals and at bedtime. It is more effective after other respiratory therapy, such as bronchodilators or nebulizer treatments. The procedure should be done three to four times each day. When drainage is done after meals, it may cause the child to vomit.

A 10-year-old female child requires daily medications for a chronic illness. Her mother tells the nurse that she is always nagging the child to take her medicine before school. What is the most appropriate nursing action to promote the child's compliance? 1. Establishing a contract with her, including rewards 2. Suggesting time-outs when she forgets her medicine 3. Discussing with her mother the damaging effects of nagging 4. Asking the child to bring her medicine containers to each appointment so they can be counted

1. Establishing a contract with her, including rewards For school-age children, behavior contracting associated with desirable rewards is an effective method for achieving compliance. Time-outs should be used only if the behavioral contracting is not successful. Although nagging is not an effective strategy, the nurse needs to assist the mother in problem-solving rather than criticize the actions. Monitoring the medicine supply may be tried if the contracting is not successful.

The nurse observes erythema, pain, and edema at a child's intravenous (IV) site with streaking along the vein. What should the nurse do first? 1. Immediately stop the infusion. 2. Check for a good blood return. 3. Ask another nurse to check the IV site. 4. Increase the IV drip for 1 minute and recheck.

1. Immediately stop the infusion. This describes an extravasation/infiltration. The IV must be stopped to prevent further damage to the child. A blood return suggests that the IV catheter is still within the vein, but the description here is a definition of an infiltrated IV. The site can be checked after the IV is stopped. The IV drip should not be increased. It will add additional fluid to the child's tissue.

A 7-year-old female child has a fever associated with a viral illness. She is being cared for at home. The nurse should recognize that the principal reason for treating fever in this child is what? 1. Relief of discomfort 2. Reassurance that illness is temporary 3. Prevention of secondary bacterial infection 4. Prevention of life-threatening complications

1. Relief of discomfort Relief of discomfort is the primary reason for treating a fever with pharmacologic or environmental interventions. Treatment does not provide reassurance that illness is temporary. Fever-reducing medications (acetaminophen and ibuprofen) do not have antibacterial actions and may inhibit the fever-enhancing effects on the immune system. Fever-reducing medications do not prevent life-threatening complications.

It is time to give a 3-year-old boy his medication. Which approach is most likely to receive a positive response? 1."Wouldn't you like to take your medicine?" 2. "See how nicely this boy took his medicine? Now take yours" 3. "You must take your medicine, because the doctor says it will make you better." 4. "It's time for your medication now. Would you like water or apple juice afterward?" Posing a question with two acceptable options provides the child

2. "See how nicely this boy took his medicine? Now take yours"

The nurse finds that a patient has developed tachycardia and tachypnea after administration of a muscle relaxant. What is an appropriate nursing action? 1. Administer an inhaled anesthetic. 2. Administer dantrolene sodium intravenously. 3. Use hot compresses on the neck and axillae. 4. Assess the patient's history of surgical procedures.

2. Administer dantrolene sodium intravenously. The nurse should administer dantrolene sodium intravenously as the patient is showing signs of malignant hyperthermia (MH). Symptoms of MH include hypercarbia, elevated temperature, tachycardia, tachypnea, acidosis, muscle rigidity, and rhabdomyolysis. The nurse uses ice packs on the groin, axillae, and neck as MH is usually accompanied by hyperthermia. A family or previous history of sudden high fever associated with a surgical procedure and myotonia increase the risk for MH. But the patient will not be assessed for it now as MH has already set in. Use of inhaled anesthetics increase the risk of MH; therefore, they should not be administered as the patient is exhibiting symptoms of MH.

What is an important consideration for the patient receiving gavage feeding? 1. The tube may infect the mouth. 2. Careful hand washing is necessary. 3. The tube should not be changed for 1 week. 4. The tube is routed through the small intestine.

2. Careful hand washing is necessary. The nurse should practice meticulous hand washing during the procedure to prevent bacterial contamination of the feeding, especially during continuous-drip feedings. Infection of the mouth is not a risk; contamination of feeding is the concern. In older children, the tube is usually taped securely in place between feedings. When this is done, the tube should be removed and replaced with a new tube frequently. The gavage tube is passed directly into the stomach through either the nostrils or the mouth.

The nurse is caring for a child after surgery. The child refuses to eat any food for lunch. What is an appropriate intervention by the nurse? 1. Call the child's parents. 2. Give the child a favorite food. 3. Refer the matter to the dietician. 4. Insist that the child eat some more food.

2. Give the child a favorite food. Although it is best to provide high-quality, nutritious foods, the child may desire foods and liquids that contain mostly empty or non-nutritional calories. Some well-tolerated foods include gelatin, diluted clear soups, carbonated drinks, flavored ice pops, dry toast, and crackers. Even though these substances are not nutritious, they can provide necessary fluid and calories. The nurse should not force the child to eat. Forcing a child to eat meets with rebellion and reinforces the behavior as a control mechanism. Calling the child's parents may make the child more irritated. The dietician is referred to before meal planning, and is consulted only if the child refuses to have any hospital food.

The nurse is educating new parents about the prevention of sudden infant death syndrome (SIDS). What position does the nurse tell the parents is the best sleeping position for their infant? 1. Prone 2. Supine 3. On a chair 4. On the side

2. Supine The safest sleeping position to prevent SIDS is wholly supine. No pillows should be placed in a young infant's crib while the infant is sleeping. Lying prone or lying on the side can raise the risk of sudden infant death syndrome because the infant's nose may get covered by the bed. Putting the child on a chair may be unsafe because the child may fall off of the chair.

The nurse is caring for a 10-year-old patient after surgery. The nurse gives the patient an inhaled anesthetic for pain relief. What is an important consideration for the patient? 1. The patient may develop asthma. 2. The patient may develop tachycardia. 3. The patient may still feel intense pain. 4. The patient may need hyperventilation.

2. The patient may develop tachycardia. In susceptible children inhaled anesthetics and the muscle relaxant succinylcholine trigger malignant hyperthermia (MH), producing hypermetabolism. Symptoms of MH include hypercarbia, elevated temperature, tachycardia, tachypnea, acidosis, muscle rigidity, and rhabdomyolysis. Inhaled anesthetics are used for asthma; they are not contraindicated for asthma. The patient will require hyperventilation only when MH gets confirmed through diagnosis. The patient is likely to feel less pain after the administration of the anesthetic.

What action does the nurse take to prevent ventilator-associated pneumonia for the patient receiving mechanical ventilation? 1. Keep oral care to a minimum. 2. Use aggressive hand hygiene 3. Provide the prescribed analgesia. 4. Elevate the bed to about 90 degrees.

2. Use aggressive hand hygiene Ventilator-associated pneumonia is a complication that can be prevented through the use of aggressive hand hygiene. The nurse ensures oral care as oral care prevents the development of harmful bacteria in the mouth. The nurse also elevates the head of the bed between 30 and 45 degrees, unless contraindicated. Analgesia is given to relieve pain and does not reduce the risk of ventilator-associated pneumonia.

The patient has not responded well to oral rehydration therapy, and a peripheral IV must be placed to allow for intravenous fluid administration. Keep in mind that the patient is a 13-month-old toddler. He has recently learned to walk and appears to favor his left hand for sucking his thumb. After explaining the treatment plan to the parents, the nurse must select the most appropriate site for peripheral IV insertion. Review the illustrations, and select the optimal site for this patient.

2. median cubital vein, basilic vein , cephalic vein, palmar sido, median vein Superficial veins of the scalp are easy to access and have no valves; however, they should be used only on infants up to 9 months old. Foot veins should be avoided in toddlers who are learning to walk or already walking. The patient's favored hand (in this case his left) should be avoided if at all possible. Therefore, for this patient the median, basilic, or cephalic veins in the right arm are the most appropriate choice for IV access. It is best to start with the most distal site, and it is important that the nurse adequately protect the site.

When is informed consent valid? Select all that apply. 1. Universal consent is used. 2. It is completed only for major surgery. 3. A person is over the age of majority and competent. 4. Information is provided to make an intelligent decision. 5. The choice exercised is free of force, fraud, duress, or coercion.

3, 4, 5 The age of majority is usually 18 years. The term competent is defined as possessing the mental capacity to make choices and understand their consequences. Enough information is provided so that the person can make an intelligent decision. The person giving consent does so voluntarily; that is, freely without coercion, any form of constraint, force, fraud, duress, or deceit. Universal consent is not sufficient. Informed consent must be obtained for each surgical or diagnostic procedure. Informed consents must be obtained for major and minor surgery, diagnostic tests, medical treatments, release of medical information, postmortem examination, removal of a child from the health care provider against medical advice, and photographs for medical, educational, or public use.

The nurse is caring for a teenager scheduled for surgery. What criteria does the nurse use to obtain valid consent from the patient? Select all that apply. 1. The patient should be healthy. 2. The patient should be intelligent. 3. The patient should act voluntarily. 4. The patient should be well-informed. 5. The patient should be over the age of majority.

3, 4, 5 To obtain valid informed consent, health care providers must meet three conditions. The person must be capable of giving consent; he or she must be over the age of majority. The person must receive the information needed to make an intelligent decision. The person must act voluntarily when exercising freedom of choice. The intelligence of the patient is not measured; the patient is only required to be competent enough to make decisions.

What does the nurse keep in mind while administering an enema to a child? 1. Pillows should not be used during the procedure. 2. The nurse should not give details about the procedure. 3. The buttocks of the child should be held together briefly. 4. Administration of enemas should be noninvasive in children.

3. The buttocks of the child should be held together briefly. Infants and young children are unable to retain the solution after it is administered, so the buttocks must be held together for a short time to retain the fluid. A careful explanation may help ease any concerns or fears the child may have about the procedure. The enema is administered and expelled while the child is lying with the buttocks over the bedpan and with the head and back supported by pillows. An enema is an intrusive procedure.

A 13-year-old patient with an ankle injury requires minor surgery. The parents of the patient have given their consent but are unable to wait during the procedure. What is the best nursing action in this context? 1. Persuade the parents to be with the patient. 2. Ask the patient's school teacher to be present. 3. Adhere to the parents' wishes of not participating. 4. Conduct the surgery when either parent is available.

3. Adhere to the parents' wishes of not participating. The nurse should support parents who do not want to be present in their decision and encourage them to remain close by so they can be available to support the child immediately after the procedure. The nurse should not insist that the parents sit through the procedure as it can create tension between the parents and the child. Reaching the patient's school teacher is inappropriate if parents are around and have decided not to stay. Waiting for either parent to sit through the procedure may delay treatment unnecessarily.

What type of enema is the nurse most likely to use for a child? 1. Plain water 2. Fleet enema 3. An isotonic solution 4. Commercial enema

3. An isotonic solution An isotonic solution is used in children. Plain water (hypotonic) is not used because it can cause rapid fluid shift and fluid overload. The Fleet enema is not advised for children because of the harsh action of sodium biphosphate and sodium phosphate. Commercial enemas can be dangerous to patients with megacolon and dehydrated or azotemic children.

The nurse is caring for a child recovering from ankle surgery. The child was administered an anesthetic for pain relief. What does the nurse do to prevent respiratory complications during the postoperative care? 1. Change the child's position every 24 hours. 2. Conduct hyperventilation with 100% oxygen. 3. Encourage respiratory movement with incentive spirometers. 4. Initiate cooling measures such as ice packs to the groin and axillae.

3. Encourage respiratory movement with incentive spirometers. To prevent pneumonia and other respiratory complications after surgery, the nurse encourages respiratory movement with incentive spirometers or other motivating activities. Hyperventilation with 100% oxygen and cooling measures such as applying ice packs to the groin and axillae are done when malignant hyperthermia (MH) is diagnosed. The child's position is changed every 2 hours and deep breathing is encouraged.

The nurse finds that a child under care for a gastrostomy experienced fecal incontinence. What is a priority intervention by the nurse? 1. Use a disinfectant immediately on the skin. 2. Elevate the bed no more than 30 degrees. 3. Gently clean the skin and remove moisture. 4. Use an adhesive remover to remove fecal matter.

3. Gently clean the skin and remove moisture. Fecal incontinence, especially when mixed with urine, wound drainage, or gastric drainage around gastrostomy tubes can erode the epidermis. The nurse should gently clean the skin and remove the excess moisture. A disinfectant is used when there is a risk of infection and the skin barrier is damaged. Elevating the bed to no more than 30 degrees for short periods prevents friction injuries. Adhesive remover is used to remove adhesives and may not be effective for removing fecal matter.

What is included in standard precautions for infection control? 1. Gloves are worn any time a patient is touched. 2. Masks are needed only when caring for patients with airborne infections. 3. Gloves are worn to change diapers when there are loose or explosive stools. 4. Needles are capped immediately after use and disposed of in a special container.

3. Gloves are worn to change diapers when there are loose or explosive stools. Gloves are not indicated unless there is potential for contact with body substances. Changing diapers with loose or explosive stools has the greatest risk for exposure to body substances. Needles should not be recapped. They should be disposed of in a rigid, puncture-proof container immediately. Masks are a component of transmission-based precautions and not standard precautions.

The nurse is charting the amount of food that a child ate at breakfast. The child had 2 oz of orange juice out of 4 oz, and two slices of bread out of the three slices. What is an appropriate way to record the information? 1. The child's appetite is improving. 2. Likes bread but hates beverages. 3. Had 2 oz orange juice and 2 slices of bread. 4. Ate well. Half glass of orange juice and some bread

3. Had 2 oz orange juice and 2 slices of bread Descriptions need to be detailed and accurate such as "2 oz of orange juice, 2 slices of bread." Comments such as "loves bread," "appetite is improving," or "ate well" are inadequate. They do not give accurate information and are open to interpretation.

The nurse is caring for a 9-year-old patient who is scheduled for an elbow surgery. The patient is anxious and is worried the surgery will be painful. What is an appropriate nursing action in this context? 1. Assure the patient that the procedure is pain-free. 2. Keep details about the procedure hidden from the patient. 3. Inform the patient that the procedure involves some discomfort. 4. Consult the health care provider for stronger doses of analgesics.

3. Inform the patient that the procedure involves some discomfort. The nurse should be honest with the child about the unpleasant aspects of a procedure but avoid creating undue concern. When discussing that a procedure may be uncomfortable, the nurse should state that it feels differently to different people. The nurse should not say that the procedure is painless just to allay the child's concerns. Stronger analgesics can be harmful for minors. The nurse should not keep any details hidden from the patient, because it is unethical.

The nurse is caring for an adolescent who is scheduled to undergo an appendectomy. What does the nurse ensure prior to the surgical procedure? 1. Obtain the patient's consent only. 2. Obtain consent from patient and patient's parents. 3. Obtain patient's assent and consent from parents. 4. Obtain assent from parents and patient's consent

3. Obtain patient's assent and consent from parents. Decision making involving the care of older children and adolescents should include the patient's assent (if feasible) and the parent's consent. Assent means that the child or adolescent has been informed about the proposed treatment. The patient may not have enough maturity to give consent. So obtaining the patient's consent is not necessary. Parents are the legal guardians of the patient so their consent is mandatory. Obtaining only their assent is a violation of law.

The nurse needs to take the blood pressure of a preschool boy for the first time. Which action is best in gaining his cooperation? 1. Take his blood pressure when a parent is there to comfort him. 2. Tell him that this procedure will help him get well more quickly. 3. Permit him to handle equipment and see the dial move before putting the cuff in place. 4. Explain to him how the blood flows through the arm and why the blood pressure is important.

3. Permit him to handle equipment and see the dial move before putting the cuff in place. Permitting the child to handle the equipment and see the dial move allows him to play out the experience ahead of time. The parent's presence will be helpful, but it will not alleviate fear of the unknown. The child will not be able to understand the relationship between blood pressure and feeling better. Additionally, there is no evidence that this procedure will help him get well more quickly. Explaining how blood flows through the arm is too complex for this age group.

What is a common postoperative complication of anesthesia? 1. Cardiac arrest 2. Infection of the joints 3. Respiratory tract infections 4. Resistance to anesthetic agents

3. Respiratory tract infections Respiratory tract infections are a potential complication of anesthesia, so the nurse makes every effort to aerate the lungs and remove secretions. Cardiac arrest is an emergency situation that is more likely to be the result of a persistent underlying condition. Infection of joints is extremely rare after surgery. Patients may develop resistance to antibiotics and not to anesthetics.

The nurse is administering an antipyretic medication to a child with a high fever. What action does the nurse take in the first hour after giving the medication? 1. Check the child's weight. 2. Administer another dose. 3. Check for aspirin toxicity. 4. Check the temperature again.

4. Check the temperature again. The temperature is usually retaken 30 minutes after the antipyretic is given to assess its effect but should not be measured repeatedly. Another dose is not administered before 4 hours and no more than five times in 24 hours. The child's weight is taken if fluid imbalance is suspected. Aspirin toxicity can cause hyperthermia. It is only assessed for if such toxicity is suspected.

The nurse is preparing a plan to teach a mother how to administer 1.5 teaspoons of medicine to her 6-month-old child. What should the nurse recommend using? 1. A household measuring spoon 2. A regular silverware teaspoon 3. A paper cup measure in 5-mL increments 4 A plastic syringe (without needle) calibrated in milliliters

4 A plastic syringe (without needle) calibrated in milliliters A plastic syringe offers the most accurate measurement. The nurse should teach the mother to give the child 7.5 mL of the medication. Household measuring spoons can be used if other more precise devices are not available. A dinner table utensil is not acceptable because household teaspoons vary greatly in size. A paper cup does not contain calibration for the additional 2.5 mL that is needed.

The nurse administers isoflurane (Forane) to a child for pain relief. What complication does the nurse anticipate in the child? 1. Increased temperature 2. Increased respiratory rate 3. Increased risk of infection 4. Decreased blood pressure

4. Decreased blood pressure Vasodilating anesthetic agents such as halothane (Fluothane), isoflurane (Forane), or enflurane (Ethrane) cause a decrease in blood pressure. Increased respiratory rate can be caused by fluid volume excess, hypothermia, or respiratory distress. Vasodilating anesthetic agents decrease the temperature as opposed to increasing it. Anesthetic agents have no effect on the risk of infection.

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)? 1. It does not need to pierce the skin for access. 2. It is easy to use for self-administered infusions. 3. It cannot dislodge from the port when the child plays with the port site. 4. It does not need to limit regular physical activity, including swimming.

4. It does not need to limit regular physical activity, including swimming. Because this device is totally under the skin, there are no activity limitations for the child. The port has to be accessed with a special needle. Because the port is totally under the skin, a needle must be used to access the port. The port site is under the skin, so there is nothing for the child to play with.

A 10-year-old patient is scheduled for a minor surgery of the ankle. The patient's parents are divorced. What is an important consideration for this patient while obtaining consent? 1. Consent of both father and mother is mandatory. 2. Either the father or the mother can give consent. 3. Consent of father, mother, and the child is mandatory. 4. Only the parent with legal custody is required to give consent.

4. Only the parent with legal custody is required to give consent. As long as children are under the age of legal consent, their parents or legal guardians are required to give informed consent before medical treatment is rendered or any procedure is performed. If the parents are divorced, consent usually rests with the parent who has legal custody. Consent of both parents is not necessary. If the parents are still married, consent from only one parent is required for nonurgent pediatric care. The child's assent is taken, not consent.

The nurse is doing preoperative teaching with a child and his parents. The parents say that he is "dreading the shot" for premedication. What should the nurse's response be based on? 1. Preanesthetic medication can only be given intramuscularly. 2. The child will have no memory of the injection because of amnesia. 3. In children, the intramuscular route is safer than the intravenous (IV) route. 4. Preanesthetic medication should be atraumatic, using oral, existing intravenous, or rectal routes.

4. Preanesthetic medication should be atraumatic, using oral, existing intravenous, or rectal routes. The necessity of premedication is being investigated. If necessary, numerous drug regimens and routes exist. Preanesthetic medicines can be given in a variety of routes other than intramuscular. The IV route is preferable. The muscle may be sore following the injection.

The nurse is educating a 7-year-old patient and the patient's family about a scheduled ankle surgery. The patient is very distractible and seems to show little interest. What is an appropriate nursing action in this context? 1. Ask parent to teach the child later. 2. Give sweets to the child to attract attention. 3. Administer coffee to the child to retain attention. 4. Schedule another individual session with the child.

4. Schedule another individual session with the child. Children who are distractible and highly active or those who are "slow to warm up" may need individualized sessions that are slowly paced. One session may not be sufficient for educating them if they are not paying attention. Giving sweets to the child may make the child demand sweets in every session, and will not result in effective learning. Giving coffee to children is inappropriate as caffeine can be too strong for them. Asking parents to teach the child later may not be effective because parents may not be able to recall enough information.

The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. What should be the next action by the nurse? 1. Notifying the surgeon 2. Performing oral intubation 3. Trying to insert a larger-size tube 4. Trying to insert a smaller-size tube

4. Trying to insert a smaller-size tube A smaller-size tube should be available. This will keep the stoma open until further action can be taken. Notify the surgeon after the emergent situation is handled. Oral intubation is done if a tube cannot be inserted. A larger tube would cause trauma to the trachea.

The nursing instructor is teaching students about the prevention of falls in children. Which statement by the student indicates a need for additional teaching? 1. Keep dim lights while sleeping. 2. Offer toileting on a regular basis. 3. Ensure appropriate gowns for the child. 4. Unlock wheelchairs before transferring.

4. Unlock wheelchairs before transferring. Appropriate measures are to be taken to prevent falls in children. The nurse should lock wheelchairs before transferring patients. The nurse should ensure appropriate gowns for the child to prevent the child from tripping. The nurse offers toileting on a regular basis as children are prone to falls in the toilet. Dim lights should be used at night for safety.

The nurse is caring for an infant in the pediatric intensive care unit. What appropriate intervention does the nurse use to minimize shear injuries? 1. Using moisturizing lotions and creams 2. Using customized splinting over infants' heels 3. Using gel pillows under the heads of the infant 4. Using lift sheets when repositioning the patient

4. Using lift sheets when repositioning the patient Prevention of shear injury includes using lift sheets when repositioning a patient, and elevating the bed no more than 30 degrees for short periods. A knee gatch is also used to interrupt the pull of gravity on the body toward the foot of the bed. Prevention of friction injury includes the use of customized splinting over infants' heels, gel pillows under the heads of infants and toddlers, and using moisturizing creams and lotions.