PREPU chapter 13

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?

244mg/dose

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.

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 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."

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 will be sure to not give too much of the liquid medication at one time." "I shouldn't use a liquid dropper from my kitchen because it may be a different measurement than one from the pharmacy." "I need to make sure to use the medicine dropper the pharmacy gives me instead of the syringe I use for my B12 injections."

The nurse is teaching parents of a 12-year-old child how to administer otic medication. Which statement by the parent indicates a need for further education?

"I will pull the outer ear down and back before administering the medication."

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."

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."

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 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 caring for a child who weighs 31 kg. A medication is ordered for this child with a dosage range of 20 to 40 mg per kg of body weight per dose. Which dosage would be appropriate for the nurse to administer to this child in one dose?

1,000 mg per dose

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 4-year-old child is being prepared to undergo a bronchoscopy to remove an aspirated pea. The nurse knows that the parents need additional teaching based on which statement?

"We will be able to take our child home immediately after the procedure is completed."

The child weighs 27 kg. Using the following formula, calculate how many milliliters of intravenous fluids should be administered to the child in a 24-hour period. Record your answer using a whole number.Formula:100 milliliters per kilogram of body weight for the first 10 kilograms50 milliliters per kilogram of body weight for the next 10 kilograms20 milliliters per kilogram of body weight for the remainder of body weight in kilograms

1540

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 mL

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 42 lb (19 kg). The medication prescribed for the child has a therapeutic dosage range of 33 mg/kg/day to 48 mg/kg/day. The medication prescribed is to be given 3 times per day. Which dosage would the nurse identify as being appropriate to administer to this child in one dose?

250 mg

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.

35g

The nurse is caring for a 12-year-old post-appendectomy client who weighs 86 pounds. The child has a temperature of 38.5ºC (101.3ºF). The nurse prepares to give the client a dose of oral acetaminophen. The order reads "Tylenol 15mg/kg/dose every 4 to 6 hours PO PRN for fever or pain." How many milligrams of Tylenol should the nurse give the client?

587 milligrams

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

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.

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/ "therapeutic hug"

Which medication is a respiratory stimulant?

Aminophylline

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.

Prior to administering an intermittent tube feeding, which action should be performed?

Assess tube placement.

The nurse has a prescription to obtain a stool specimen from a child who is not toilet-trained. Which is the best process when it is important to keep urine from contaminating the specimen?

Attach a urine collector bag and scrape stool from the diaper.

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

When considering the developmental pharmacokinetics of children, what accurately describes the factors that affect medication distribution in children?

Children have a higher proportion of total body water, a lower proportion of body fat, and an immature blood-brain barrier.

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.

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.

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.

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.

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.

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.

A nurse inserts a nasogastric (NG) tube into a child for enteral feeding. How will the nurse ensure appropriate placement of the tube after insertion?

Obtain radiologic confirmation.

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

A child is having difficulty swallowing pills. What is the best action for the nurse to take to help this child swallow medications?

Place the pills in a bite of ice cream or applesauce.

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 pediatric client is having difficulty breathing. Which nursing intervention is appropriate for this client?

Provide oxygen as needed to maintain oxygen saturation above 93%.

A nurse is administering ear drops to a 7-year-old girl. What should the nurse do?

Pull the pinna of the ear up and back to straighten the external ear canal.

The nurse is caring for a comatose school-age child receiving gastrostomy tube feedings. The nurse aspirates 15 ml of stomach contents prior to administering a feeding. What is the appropriate action by the nurse?

Replace the stomach contents and continue with the feedings as prescribed.

What is the best method for the nurse to reduce the pain of an IM injection for a child?

Request an anesthetic cream to apply before injection.

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 preparing to give a diphtheria, pertussis, and tetanus (DPT) immunization to a child in an acute care setting before discharge. The label on the DPT bottle indicates the immunization expired yesterday. What is the correct nursing action to take?

Return the bottle to the pharmacy and request a replacement.

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."

The nurse is administering a PRN pain medication to a child. What is the highest priority for the nurse in this situation?

The nurse double-checks the medication calculation with another nurse.

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.

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.

An infant is to have a scalp-vein intravenous infusion begun. What is an advantage of this insertion site?

The scalp veins are easily visualized.

The parent of a child with a central venous catheter expresses concern about whether the catheter could fall out when the child goes home. What is the nurse's best response?

There is a tiny cuff under the skin that secures the catheter.

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

The nurse is administering total parenteral nutrition to a pediatric client. How often should the nurse monitor the child's blood glucose level during the initial phase of the infusion?

every 4 to 6 hours

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 neonatal nurse is preparing to start an IV. Which IV site can be used when initiating an IV in a newborn? Select all that apply.

foot dorsal surface of hand scalp leg flexor surface of the wrist

The site most often used when administering a medication using the intradermal route is the:

forearm.

The new graduate nurse is preparing to administer medication to a 4-year-old client. When would it be appropriate for the supervising nurse to intervene? The new graduate:

had two whole tablets to administer to the child.

The charge nurse is assisting the new graduate nurse in administering eye drops to a child. The charge nurse would stop the new graduate if which action was observed?

holds the eyelids apart for about 30 seconds

The primary health care provider prescribed ketoconazole for a child with ringworm. Which statement by the parents indicates the nurse needs to provide additional teaching on the prescription?

"I will wrap the skin tightly after applying the medication."

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 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 preparing to administer an oral dose of antibiotics to a 10-year-old child who weighs 70 lb (31.8 kg). The prescription reads cephalexin 500 mg orally every 6 hours. The pediatric drug reference identifies the safe dosing as 25-100mg/kg/day in 2 to 4 divided doses. Which safe range per dose does the nurse calculate?

199 mg to 795 mg per dose

The nurse is preparing to administer an oral dose of antibiotics to a 10-year-old child who weighs 70 lb (31.75 kg). The prescription reads cephalexin 500 mg orally every 6 hours. The pediatric drug book dosing reads 25 to 100 mg/kg/day in 2 to 4 divided doses. What is the safe range per dose if administering every 6 hours for this client?

199 to 794 mg per dose

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

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.

A child with HIV, weighing 25 kg (55.1 lbs), is about to receive an infusion of IVIG. The recommended dose is 400 mg/kg/dose. The medication is available in a concentration of 50 mg/mL. What is the proper amount of infusion that the child will receive?

200mL

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 caring for a 7-year-old with a low-profile gastrostomy tube placed 6 months ago. Which is the priority intervention to prevent irritation of the skin at the insertion site?

cleaning the surrounding skin with soap and water daily plus keeping the area dry

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.

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