Peds Chapter 35: Key Pediatric Nursing Interventions
A nurse is educating the parents how to administer daily oral medication to their 5-year-old boy. Which response indicates a need for further teaching?
"He needs to take his medicine or he will lose a privilege."
The nurse enters the room to give a subcutaneous injection of insulin to a 6-year-old child with diabetes. What is the best method of medication administration?
Ask the child where the child would like to have the injection.
The nurse is teaching a parent how to administer otic medications to her 4-year-old child. Which comment from the mother would indicate the need for further teaching?
"I will pull the pinna down and back."
A health care provider has prescribed hydroxyurea 20 mg/kg to a child as part of a treatment regimen for sickle cell disease. The child weighs 27 lb (12.2 kg). How many milligrams should the nurse administer?
244
The nursing is teaching parents how to administer a prescribed otic medication for a 2-year-old toddler with otitis media. Which statement will the nurse include in the teaching?
"Be sure the ear drops are at room temperature before administering."
A 4-year-old child is admitted to the hospital for surgery. Before the nurse administers medicine, the best way to identify the child would be to:
read the child's armband.
A child is being discharged from the hospital and the nurse has completed discharge teaching regarding prescribed liquid medications. Which comments by the parent demonstrates understanding of discharge instructions for safe medication administration? Select all that apply.
"I need to make sure to use the medicine dropper the pharmacy gives me instead of the syringe I use for my B12 injections." "I shouldn't use a liquid dropper from my kitchen because it may be a different measurement than one from the pharmacy." "I will be sure to not give too much of the liquid medication at one time."
The nurse has finished completing a client education program for parents on proper medication administration to children. Which statement by a parent would indicate a need for further education?
"If my toddler won't swallow her medication, I will hold her nose until she has to swallow."
The nurse is teaching a parent how to instill ophthalmic ointment to the child. Which comment by the parent would indicate the need for further teaching by the nurse?
"My other children can share the same eye ointment."
The nurse is caring for a 4-year-old child who requires a venipuncture. To prepare the child for the procedure, which explanation is most appropriate?
"The doctor will look at your blood to see why you are sick."
A child who is receiving TPN has developed the need to have insulin injections. The child's mother questions this and states that her child does not have diabetes. What is the appropriate response by the nurse?
"The feedings are high in sugar and insulin is needed to manage this."
The nurse is educating the parents of a 5-month-old on how to administer an oral antibiotic. Which response indicates a need for further teaching?
"We can mix the antibiotics into his formula or food."
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
The nurse is calculating the urinary output for the infant. The infant's diaper weighed 40 g prior to placing the diaper on the infant. After removal of the wet diaper, the diaper weighed 75 g. How many milliliters of urine can the nurse document as urinary output? Record your answer using a whole number.
35
The nurse is preparing to administer medication to a 10-year-old who weighs 70 lb (32 kg). The prescribed single dose is 3 to 4 mg/kg per day. Which dose range is appropriate for this child?
96 to 128 mg
The mother of a 9-year-old girl calls the physician's office complaining that her daughter continues to vomit soon after being given an oral amoxicillin capsule for her strep throat. The nurse recognizes that the child's vomiting will interfere with which pharmacokinetic process?
Absorption
A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2 saturation 95% on room air. Which action will the nurse take first?
Administer the bronchodilator via a nebulizer.
A neonate is to receive a hepatitis B vaccine within a few hours after birth. What is the best approach for the nurse to take when giving this medication?
Administer the medication in the neonate's vastus lateralis with a 25-gauge needle.
The nurse is caring for a 5-year-old in a clinic setting. The client is due for a scheduled immunization. Which approach is the best for the nurse to take when administering the IM injection?
Allow the child to pick which arm the injection will go in.
An infant is scheduled to have a painful procedure performed. Which nursing action provides the best support for the parents and infant?
Allow the parents to hold the infant during the procedure.
The nurse is caring for a child with an ileostomy. What nursing intervention will be included in this child's plan of care?
Check for leakage around the stoma.
The nurse is preparing to administer regular insulin to a nonverbal pediatric client. Which action will the nurse perform prior to administering the medication?
Check the full name and birth date on the client's wristband with the medication administration record.
The nurse is caring for a child with a nasogastric tube that has been in place for several days. It is time to administer the liquid feeding. What is the priority nursing action?
Check the length of the tube extending from the nose against the measurement recorded when the tube was placed.
The nurse is preparing to administer a PO medication to a 6-year-old in the hospital for an exacerbation of asthma. The nurse notes that the child is due for an oral dose of lansoprazole in 1 hour. What is the most important action for the nurse to take before administering this medication to the client?
Clarify the order, since there is no apparent link between the client's diagnosis and the medication.
A 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 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 nurse administers an antipyretic rectal suppository. The child has a bowel movement 15 minutes later. What is the appropriate nursing action?
Examine the stool for the presence of the suppository.
A nurse has been administering normal saline intravenously to a pediatric client and notes edema, pallor, and blanching at the intravenous site. What should the nurse do next?
Discontinue the infusion and remove the cannula.
A toddler requires 1.5 ml of an antibiotic given intramuscularly (IM). How will the nurse administer this medication?
Divide the dose. Administer 0.75 ml IM in each vastus lateralis.
The pediatric nurse recognizes that what statement is true regarding medications administered via the intravenous route?
Giving medications through the intravenous route is less traumatic than multiple injections.
The nurse is assessing a child who is receiving TPN. The nurse determines the TPN bag was hung 24 hours ago. What initial action by the nurse is indicated?
Hang a new bag of TPN.
When assessing a caregiver's knowledge of proper medication administration, which is the best way for the nurse to determine the caregiver's knowledge?
Have the caregiver give a demonstration of the medication administration to the nurse before discharge.
A health care provider has written several prescriptions for a 7-pound newborn with jaundice. Which prescription does the nurse need to question?
IV normal saline 20 ml/hour
The nurse has prepared an IM injection to give a 13-year-old child. After some searching, the nurse locates the child in the playroom in front of a video game. Which action is best for the nurse to take?
Inform the child that it is time for an injection. Explain why the injection is needed and have the child move to the treatment room.
The nurse is administering an oral liquid medication to a 5-year-old child. What would be the most appropriate for the nurse to do when administering this medication?
Let the child hold the medication cup.
The nurse is caring for a child prescribed ophthalmic drops. Place the steps in the order the nurse will complete them when administering the ophthalmic medication to the child. Use each option once.
Place the child in the supine position, slightly hyperextending the neck with the head lower than the body Retract the lower conjunctival sac Place the prescribed number of drops into the lower eyelid Instruct the child to gently close the eyes Wipe any excess medication from the skin
To give eardrops to a 4-year-old child, what would be the best technique to use?
Pull the pinna of the ear up and back.
A parent informs the nurse about having a hard time getting her 6-year-old child to take the liquid medication at home. Which would be the best suggestion for the nurse to offer the parent to help correct this concern?
Tell the parent to state firmly, "It's time for you to drink your medicine."
When administering medications to an infant, what information will the nurse consider?
The oral medication should be directed toward the side of the mouth when using a syringe or dropper.
The student nurse is preparing to care for a recently placed gastrostomy tube. Which action would prompt further instruction from the overseeing nurse?
The student obtains an antimicrobial soap to clean the area surrounding the tube.
The nurse is preparing to administer a medication via a syringe pump as ordered for a 2-month-old girl. Which is the priority nursing action?
Verify the medication order.
The nurse is working with parents who administer cycled total parenteral nutrition (TPN) over a 12-hour period at night to free their teenage son for activities during the day. In teaching this family, what areas would the nurse stress? Select all that apply.
administering the solution at half-rate during the first and last hour of the infusion inspecting the insertion site of the catheter regularly
The nurse is working to gain a preschooler's cooperation to swallow an oral medication. What would be the nurse's best approach?
ask if the child would like to take the medicine in a cup or through an oral syringe
A medical/surgical nurse has been floated to the pediatric unit. Which action by the float nurse would require the pediatric nurse to intervene?
asking the child his or her name prior to giving medications
The nurse has just inserted a nasogastric tube for an enteral feeding in a 6-month-old infant. The best way to assess whether the tube has reached her stomach is to:
aspirate the tube for stomach contents.
The nurse is preparing a subcutaneous insulin injection for a preschooler. How and where should the nurse administer the insulin?
at a 45- to 90-degree angle into the elevated tissue of the upper arm
The nurse is caring for a child with an intravenous device in the hand. Which sign would alert the nurse that infiltration is occurring?
cool, puffy skin
The 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
The nurse is testing the pH of contents aspirated from a gavage feeding tube to confirm placement. Which finding indicates likely intestinal placement?
pH 7.0
The nurse is preparing to give a 4-month-old an oral medication. Which technique demonstrates the nurse's accurate knowledge of the infant's developmental level?
Position the infant upright, offer the infant a bottle of formula, remove the bottle and squirt the medication on the side of the tongue toward the cheek, then offer the infant the bottle again.
A father believes his 2-year-old son is frightened by seeing an intramuscular (IM) medication injected into his thigh and requests that the child's "butt" be used. What will be the nurse's response?
"The muscle in his butt is not well enough developed to receive this injection until he has walked for 1 year."
The nurse is preparing to administer an intramuscular immunization to a 5-year-old child. What statement to the child is appropriate for inclusion in the preadministration period?
"This will help prevent you from getting sick."
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."
The nurse is preparing to administer an antibiotic for a severe respiratory infection to a 5-year-old boy. The child asks the nurse why he is getting this medication. What is the best response by the nurse?
"The medicine will help you feel better so that you can go home soon."
The nurse is providing discharge education to the parents of a 2-year-old who will be taking amoxicillin orally at home. The nurse would include which statement in the teaching?
"Use a dosing cap to measure the dosage."
The nurse is showing the student nurse how to flush a pediatric client's peripherally inserted central catheter (PICC) line. The nurse prepares a 3-ml normal saline flush using a 5-ml syringe. The student asks the nurse why the flush was prepared this way. What is the most accurate response by the nurse?
"Using a larger-volume syringe exerts less pressure on the PICC line."
The nurse provided education on enteric-coated aspirin to a pediatric client's parents. Which statement by the parents indicates additional teaching is needed?
"We will give this medication to our child at bedtime each day."
A nurse is providing care for a child diagnosed with beta-thalassemia. The child requires a blood transfusion of packed red blood cells (PRBCs). The health care provider has prescribed a transfusion volume of 10 ml/kg. The child weighs 37 lb (16.8 kg). How many milliliters should the nurse infuse?
168
The child weighs 47 pounds. How many kilograms does the child weigh? Record your answer using one decimal place.
21.4
The nurse is caring for a child who weighs 75 lb. The medication ordered for the child has a therapeutic dosage range of 33 mg/kg per day to 48 mg/kg per day. The medication ordered is to be given 4 times per day. Which dosages would be appropriate for the nurse to administer to this child in one dose?
375 mg per dose
The nurse is preparing to administer oral ampicillin to a child who weighs 40 kg. The safe dose for children is 50 to 100 mg/kg/day divided in doses administered every 6 hours. What would be the low single safe dose and high single safe dose per day for this child?
500 to 1,000 mg per dose
The pediatric nurse is bringing the prescribed medication for a child but notes that the identification band is missing. The parents are at the bedside holding the child. What is the best method for identifying the child?
Ask the parents to tell you the child's name and date of birth.
Prior to administering an intermittent tube feeding, which action should be performed?
Assess tube placement.
A child needs a peripheral IV start as well as a venous blood sample for a laboratory test. The nurse will take what action?
Coordinate placing the peripheral IV and the lab blood draw.
A nurse is preparing a dose of insulin to give the client. Which action takes priority when preparing and administering this medication?
Double-check the dose with another RN before giving.
When performing a procedure on a child in the health care setting, what should the priority intervention by the nurse be?
Ensuring the child's safety
Included in the nursing care plan for the child receiving total parenteral nutrition (TPN) will be which intervention?
Regularly monitoring the child's blood glucose
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.
The nurse is administering a PRN pain medication to a child. What is the highest priority for the nurse in this situation?
The nurse checks the last time the medication was given.
The nurse is administering medications to a 10-year-old child who takes medications at home for a chronic condition. The child's parent is at the bedside. What are appropriate guidelines for medication administration to this client? Select all that apply.
The nurse compares the child's ID band with the medication record. The nurse carefully reads the label on the side of the medication bottle. The nurse documents the medication administration after giving the medication.
The nurse is preparing to administer an intramuscular immunization to a 5-year-old child. What statement to the child is appropriate for inclusion in the preadministration period?
"This will help prevent you from getting sick." A
A 5-year-old boy is receiving an analgesic intravenously while in the hospital. What should the nurse do to determine whether the drug is being properly excreted from this child?
Monitor the child's fluid intake and output.
Parents asks the nurse why their premature infant is receiving a feeding through the mouth rather than the nose. What is the best explanation by the nurse?
Newborns are obligate nose breathers so nasogastric may obstruct their breathing.
While working in the emergency room, the nurse receives a call that a 3-year-old child sustained extensive burns in a house fire. Assuming all of the following actions are included in the standing burn-care protocol, which action should be the nurse perform first?
Obtain a weight.
A preschool-age child who is receiving gastrostomy feedings occasionally vomits following a feeding. When the parent describes the feeding process, what does the nurse note as the likely cause of the vomiting?
The mother does not check gastric residual prior to feedings.
The nurse is preparing to administer an oral dose of metoclopramide to a 5-year-old child who weighs 40 lb (18.2 kg). The prescription reads metoclopramide 0.8 mg/kg/day to be given in 4 oral doses. How many milligrams of metoclopramide would the nurse give per dose?
3.65 mg per dose
A 5-year-old child is to receive long-term IV antibiotics. The mother is concerned about what type of administration method will be used. Which medication administration route may be the most easily accepted?
A peripherally inserted central catheter (PICC) line in an antecubital space
The site most often used when administering a medication using the intradermal route is the:
forearm.
The nurse is administering a gavage feeding through a nasogastric feeding tube. Which nursing intervention is the highest priority?
The nurse verifies the position of the feeding tube.
