Chapter 35: Key Pediatric Nursing Interventions
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? "Illness can sometimes result in the need for insulin." "There is a chance these feedings your child is receiving are causing her to have diabetes." "There is no need to worry. This is temporary." "The feedings are high in sugar and insulin is needed to manage this."
"The feedings are high in sugar and insulin is needed to manage this." Explanation: Glucose levels may be elevated when TPN is administered. While illness can impact serum glucose levels, this is not an appropriate response. Telling the parent there is no need to worry minimizes concerns and is not a correct response. The child does not have diabetes but warrants insulin coverage.
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? 62.0 mg per dose 12.4 mg per dose 1,000 mg per dose 124.0 mg per dose
1,000 mg per dose Explanation: If a dosage range of 20 to 40 mg per kg of body weight is a safe dosage range, and a child weighs 31 kg, the low dose of this medication would be 31 X 20 = 620. The high dose of this medication would be 31 X 40 = 1,240. Therefore, a dose of 1,000 mg per dose would be appropriate.
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? 14.60 mg per dose 18.20 kg per dose 8.00 mg per dose 3.65 mg per dose
3.65 mg per dose Explanation: To calculate the does, use the client's weight in kilograms. Multiply 0.8 mg by 18.2 kg, which equals 14.6 mg per day for the client's weight. Then, divide 14.6 mg by 4, the number of doses per day , to arrive at 3.65 mg per dose.
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 birth date and full name on the client's wristband with the medication administration record and have another nurse verify. Check the full name and age on the client's wristband with the medication administration record and have the parent verbally confirm. Check the full name and room number on the client's wristband with the medication administration record. Check the full name and birth date on the client's wristband with the medication administration record.
Check the full name and birth date on the client's wristband with the medication administration record. Explanation: When administering medications to a child, the nurse needs to use at minimum two client identifiers that are directly associated with the client and the medication to be given, such as full name, client ID number, and birth date. The nurse will take the medication administration record to the room to perform a "double-identifier" check. A client's identity must be verified with two acceptable identifiers, not just one. There is no need to have another nurse verify or have the parent state the client's information. A room number or a bed number is not an acceptable identifier.
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? Request a chest X-ray for evaluation. Contact the health care provider. Assess intake, output, and weight. Discontinue the IV infusion.
Discontinue the IV infusion. Explanation: Signs of fluid overload are those of congestive heart failure and include coarse breath sounds, increased pulse rate, and increased blood pressure. These are not symptoms of extravasation because this would be swelling of fluid around the IV site. The nurse would need to stop the IV infusion, then assess weight, intake, and output. The nurse would then contact the health care provider.
The nurse administers an antipyretic rectal suppository. The child has a bowel movement 15 minutes later. What is the appropriate nursing action? Wait to re-administer the medication until the next scheduled dose. Recheck the child's temperature to determine if the suppository is needed. Administer another suppository, and then hold the child's buttocks together. Immediately notify the physician or nurse practitioner. Examine the stool for the presence of the suppository.
Examine the stool for the presence of the suppository. Explanation: The stool should be examined for the suppository that may have been expelled with the bowel movement. If it is found, the physician or nurse practitioner can be notified to determine if the suppository should be repeated. The nurse should not administer another dose without examining the stool or contacting the physician or nurse practitioner. Rechecking the child's temperature would provide little useful information since only a very limited time has elapsed since the temperature was last checked.
A health care provider has written several prescriptions for a 7-pound newborn with jaundice. Which prescription does the nurse need to question? serum bilirubin in AM breastfeed ad lib phototherapy IV normal saline 20 ml/hour
IV normal saline 20 ml/hour Explanation: IV fluids should be 2 ml/kg/hour, and this would calculate to 3.2 kg X 2 ml/hr = 6 ml/hour. The prescription for 20 ml/hour is too high for this newborn and would need to be questioned by the nurse. The other prescriptions are within reason.
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? Have the child lying down with the head elevated on a pillow. Let the child hold the medication cup. Ask the parent to hold the child's arms during administration. Administer the medication using a dropper.
Let the child hold the medication cup. Explanation: Droppers and oral syringes can be used to administer medications to infants and young children. Medication cups and spoons can be used to administer liquid medications to the older child. The child can hold the medication cup and drink the liquid medication. Depending upon the age of the child, he or she may still prefer to take liquid medications via the syringe. It makes taking the medication fun when the child can squirt it into the mouth by himself or herself. The child who is lying down when being given medications should have the head of the bed elevated to at least 45 degrees A 5-year-old child does not need to be restrained for medication administration.
The nurse is caring for a child receiving ibuprofen. What is priority for the nurse to do? Monitor vital signs. Monitor hemoglobin and hematocrit. Monitor liver function. Monitor intake and output.
Monitor intake and output. Explanation: Most drugs are excreted through the kidneys, so it is important to evaluate whether the kidneys are excreting the minimum hourly urine output. Vital signs might relate to infection or distribution, whereas liver function might relate to metabolism. Hemoglobin and hematocrit are unrelated to excretion of medications.
The nurse is preparing an intravenous solution of D5 ¼ NS @ 20 ml/hour for a 6-month-old client. Which safety device will be added to protect against fluid overload? a secondary line a syringe pump pediatric IV tubing a volume control device
a volume control device Explanation: A volume control device (also called buretrol) is designed to deliver only the amount of medication placed in the chamber. The nurse places no more than 2 hours of fluid within the device. Should the pump fail, the client will receive only the fluid amount in the chamber, thus preventing fluid overload.
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 scanning the child's barcode on the identification band requesting the pediatric nurse to double-check calculations speaking to both the parents and child about medications
asking the child his or her name prior to giving medications Explanation: To prevent errors, the nurse should never ask children their names for identification. This action would require the pediatric nurse to intervenes. Instead, nurses must read or scan the bar code on clients' identification arm bands and compare them with the medication sheet or electronic record. It is important to include both the parents and child in teaching about a medication. Calculating pediatric doses is not something medical/surgical nurses do on a regular basis, so it would be appropriate for the float nurse to have a pediatric nurse double-check the calculations.
Immediately following administering a medication by enteral tube, the nurse will: flush the tube with water. position the child on his left side. elevate the head of the bed. check for signs of nausea or vomiting.
flush the tube with water. Explanation: It is important to flush the tube to ensure all of the medication reaches the child's digestive tract and to prevent occlusion of the tube. Right (not left) side-lying position will aid in stomach emptying, although it was not specified that the enteral tube was located in the stomach. Elevating the head of the bed is done prior to placing material in the gastrointestinal tract. Checking for signs of nausea and vomiting is always important but does not have to be done immediately following enteral tube medication administration.
What are possible complications for a child with a vascular access port? Select all that apply. infection hemorrhage aneurysm air embolism thrombosis osteomyelitis
infection thrombosis hemorrhage air embolism Explanation: Complications of a vascular access port are infection, thrombosis, air embolism, and hemorrhage. Aneurysm and osteomyelitis are not related to having a central venous catheter.
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 should not forcibly squirt the medication in the back of his throat." "We can follow his medicine with some applesauce or yogurt." "We can mix the antibiotics into his formula or food." "We can place the medicine along the inside of his cheek."
"We can mix the antibiotics into his formula or food." Explanation: Never mix a medication with formula or food. The child may associate the bitter taste with the food and later refuse to eat it.
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. Ask the client if he or she has had any adverse reactions to insulin in the past. Double-check the math calculations. Have another RN witness the injection given to the client.
Double-check the dose with another RN before giving. Explanation: Insulin is a high-alert medication and the dosage must be checked with another RN before administering. All rights of medication administration should be adhered to. Insulin dosages come in units and the prescription is to administer a specific number of units; thus, no calculations of dosages are needed. Insulin injections do not have to be witnessed. Insulin is not known for having adverse reactions, but it is always a good practice to ask the client if he or she has experienced any problems receiving insulin.
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. Encourage the caregiver to ask the nurse questions about proper medication administration before discharge. Have the caregiver verbalize the exact steps in how to properly administer the prescribed medications. Have the caregiver watch the nurse give the medications using proper administration techniques.
Have the caregiver give a demonstration of the medication administration to the nurse before discharge. Explanation: Return demonstrations are an important evaluation tool to assess safe administration of medication. It is the preferred method to evaluate caregiver knowledge. Asking questions is important but the return demonstration is the best way to assess the caregiver's knowledge. Verbal understanding is also important, but it demonstrates knowledge not proficiency. Having the caregiver watch the nurse give the medications is teaching, not evaluation. It is not a correct way to assess the caregiver's knowledge.
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. Give a tetanus toxoid injection. Insert a nasogastric tube to empty the stomach. Ask the child to drink a glass of milk.
Obtain a weight. Explanation: A burn victim will require large amounts of fluid hydration to replace fluid losses. Obtaining a weight provides a base for calculating the fluid that will need to be replaced. Nasogastric tube placement and/or drinking milk are not actions to take at this point. Tetanus can be given later and is not critical to active management.
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? Measure the child's respiration rate. Monitor the child's fluid intake and output. Assess the child's blood pressure level. Ask the child to describe his pain level.
Monitor the child's fluid intake and output. Explanation: Monitoring intake and output is important in children receiving drugs to be certain urine excretion or an outlet for drug metabolites is adequate. The other interventions listed are not typically used to determine whether drug excretion is occurring.
A nurse who works with pediatric clients will use what device to estimate body surface area (BSA) to calculate medication dosages? Sonogram Nomogram Anagram Calculator
Nomogram Explanation: A nomogram to estimate body surface area (BSA) is used when calculating dosages for pediatric clients. A nomogram is a graph with three columns. The left column is the height. The middle column is the surface area and the right column is the weight. The nurse will measure the child's height and weight. On the graph, a line will be drawn across to connect the height and weight. The point where this intersects on the middle column is the BSA. A calculator is used often to calculate pediatric medications but it cannot calculate BSA. It determines dosage by weight. A sonogram is an ultrasound examination. An anagram is a word, phrase, or name formed by rearranging the letters from another word.
The nurse is administering otic medication to a 22-month-old with a diagnosis of otitis media. Which nursing action ensures that the medication is distributed appropriately? Pull the pinna up and back. Pull the pinna down and back. Place in a side-lying position. Place a cotton ball in the outer ear.
Pull the pinna down and back. Explanation: By making sure that the ear canal is straight for the medication to progress to the tympanic membrane, the medication is distributed appropriately. It is also appropriate to place the child in a side-lying position. Some nurses place a cotton ball in the ear but that does not impact distribution of the medication. A child over 3 years of age needs the pinna pulled up and back.
The nurse is administering a PRN pain medication to a child. What is the highest priority for the nurse in this situation? The nurse asks the child to explain the pain the child is having. The nurse documents the effect of the medication within 1 hour of administration. The nurse double-checks the medication calculation with another nurse. The nurse checks the last time the medication was given.
The nurse checks the last time the medication was given. Explanation: When giving a PRN medication, always check the last time it was given and clarify how much has been given during the past 24 hours. The other choices are important but checking when and how much the child has had are the priorities.
A school-age child is to receive insulin therapy via a subcutaneous infusion pump. When explaining this method of administration, the nurse would include which site as most likely to be used? abdomen antecubital space of the arm upper chest scalp
abdomen Explanation: With a subcutaneous infusion pump, the drug is delivered by the pump via a medicine-filled syringe. The site chosen is usually the abdomen because this both protects the pump and allows it to be out of sight. The other sites are used for other intravenous infusions.
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 leave the medicine on the night stand so the child can take it independently compare the taste of the medicine to a chocolate bar offer to play a game with the child if the child takes the medicine
ask if the child would like to take the medicine in a cup or through an oral syringe Explanation: The preschool age is when the child develops initiative. This is the sense that the child is helping. Thus, the nurse should allow the child to participate in the medication task. The instructions and choices need to be simple. The nurse can ask if the preschooler would like to take the medicine in a cup or through an oral syringe. Medicine never should be compared to candy or any other foods. Doing so can present a safety problem if the child gets into the medication cabinet at home thinking he or she is getting candy. Children cannot be depended on to take medicine without supervision, so leaving the medication on the night stand would not only be ineffective it would also be dangerous. Bribing is ineffective. A preschooler is not going to do a task he or she does not like and the medication is needed to make the child well. The nurse should be gentle but firm in the administration of the medication.
The nurse is preparing a subcutaneous insulin injection for a preschooler. How and where should the nurse administer the insulin? at a 45-degree angle into the deltoid of the upper arm at a 90-degree angle into the vastus lateralis at a 45- to 90-degree angle into the elevated tissue of the upper arm at a 45- to 90-degree degree angle into the rectus femoris
at a 45- to 90-degree angle into the elevated tissue of the upper arm Explanation: Subcutaneous administration distributes medication into the fatty layers of the body. It is used for insulin administration. Preferred subcutaneous sites include anterior thigh, buttocks, upper arms, and abdomen. The rest of the sites are intramuscular ones and not appropriate for insulin administration.
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: explained why the medication was being administered. used the child's weight to calculate the dosage. is going to give an IM injection in the vastus lateralis. had two whole tablets to administer to the child.
had two whole tablets to administer to the child. Explanation: Many children do not have enough coordination to swallow tablets or pills until they are 6 or 7 years of age. Therefore, the supervising nurse would need to intervene. The other actions are correct. The nurse should explain why the medication is being administered. Medications in children are dosed according to body weight (milligrams per kilogram) or body surface area (BSA) (milligrams per square meter). The vastus lateralis is a good location for an IM injection in a 4-year-old 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? administers drops into conjunctival sac holds the eyelids apart for about 30 seconds positions the child supine on the bed allows the child to sit up after blinking a few times
holds the eyelids apart for about 30 seconds Explanation: To prevent the conjunctiva from drying, the nurse should not hold the eyelids apart any longer than necessary. Therefore, the charge nurse would need to stop the new nurse. It is best to use the supine position. Instill the correct number of drops into the conjunctiva of the lower lid. Allow the eyelid to close. Avoid placing the drops directly on the cornea because that can be painful. To prevent the conjunctiva from drying, do not hold the eyelids apart any longer than necessary. After the child has blinked 2 or 3 times, allow the child to sit up.
The nurse needs to transport her preschool client to radiology for a chest X-Ray. Which transportation device would be most appropriate? stretcher wagon crib wheelchair
wagon Explanation: When transporting a child off the floor, the nurse needs to select the correct means of transportation based upon the child's age and developmental level. For a preschooler, a wagon would be the best choice for both safety and for enjoyment. A stretcher or wheelchair are both too large for such a young child and a crib is too small for them.
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? "Pull your toddler's ear up and back before you give the ear drops." "Place your toddler on the stomach after instilling the drops." "Massage the area posterior to the affected ear after instilling the drops." "Be sure the ear drops are at room temperature before administering."
"Be sure the ear drops are at room temperature before administering." Explanation: Otic administration refers to delivering medicine into the ear canal. To limit pain and discomfort, the ear drops should be room temperature when administered. If necessary, the container can be rolled between the palms to help warm the drops. When doing this, the ear of the child who is 2 years and younger should be pulled down and back. The ear of the child who is 3 years and older should be pulled up and back. The child should be placed supine or side-lying with the affected ear exposed, drops instilled, area anterior massaged to promote passage of the medication into the ear canal, and have the child remain in this position for a few minutes.
The child weighs 47 pounds. How many kilograms does the child weigh? Record your answer using one decimal place. _______
21.4 Explanation: There are 2.2 lb per kg. 47 lb x 1 kg/2.2 pounds = 21.363636 kg. When rounded to the tenths place, the answer is 21.4 kg.
A child on oxygen reports a "sore nose" and the nurse assesses that the child is experiencing dry nasal passages. What action can the nurse take to help relieve the child's discomfort? Place lotion on a cotton swab and gently place some inside each nostril to moisturize the nasal passages. Apply a petroleum-based lubricant such as Vaseline on and around the nose to ease the discomfort. Turn the oxygen flow rate down to reduce the amount of air passing through the child's nose. Use a water-based gel or spray for lubrication of the dry nasal passages.
Use a water-based gel or spray for lubrication of the dry nasal passages. Explanation: Any time a client is on oxygen, he or she needs to be instructed to use a non-petroleum or water-based product for dry nasal passages. Petroleum products greatly increase the risk of catching fire since they are so flammable. The nurse cannot reduce the amount of needed oxygen for the client by turning down the flow rate nor should the nurse insert lotion into the nasal passages.
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? Wash hands and put on gloves. Gather the necessary equipment and supplies. Gather the medication. Verify the medication order.
Verify the medication order. Explanation: The priority nursing action is to verify the medication ordered. The first step in the eight rights of pediatric medication administration is to ensure that the child is receiving the right medication. After verifying the order, the nurse would then gather the medication, the necessary equipment and supplies, wash hands, and put on gloves.
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? "I will be back after your IV is in place." "The client is left-handed and likes to draw; an IV site in his right arm would be best." "The nurses on the unit know the client well, so maybe a nurse could start the IV." "Would you like me to stay with you or are you OK alone?"
"The client is left-handed and likes to draw; an IV site in his right arm would be best." Explanation: The staff nurse may serve as the child's advocate when the care provider comes to start an infusion. The staff nurse who has cared for the child has the child's confidence and knows the child's preferences.
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. Administer the antibiotic IM in the rectus femoris. Reduce the volume of the dose using less diluent than recommended to prepare the antibiotic for IM injection. Seek an order for an oral form of the antibiotic.
Divide the dose. Administer 0.75 ml IM in each vastus lateralis. Explanation: The recommended amount of solution a toddler should receive in one IM injection should not exceed 1 ml. Dividing the dose is necessary even though two injections will cause additional stress. These could be given simultaneously by two nurses. Seeking an oral route could be explored, but may not be feasible. The manufacturer's directions regarding the amount of diluent should be followed to ensure safety.
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? Increase the rate of the TPN to complete the bag. Hang a new bag of TPN. Document the amount of solution left in the bag and continue the administration. Discontinue the TPN bag and notify the physician.
Hang a new bag of TPN. Explanation: TPN bags should not hang over 24 hours. The nurse should discontinue the current bag and hang a new one. There is no need to notify the physician. The rate of the TPN should never be changed without a physician's order.
A child is having difficulty swallowing pills. What is the best action for the nurse to take to help this child swallow medications? Crush all medications and dissolve in water. Place the pills in a bite of ice cream or applesauce. Hold the medication and notify the health care provider. Obtain small round candy to practice swallowing techniques.
Place the pills in a bite of ice cream or applesauce. Explanation: The most useful technique when children cannot swallow pills is to put them into some ice cream or applesauce. This allows the medication to be administered in the original form. The nurse should not use candy for practice, because this may suggest to the child that medicine is the same as candy. The nurse should never crush medications which are enteric coated or time released. The nurse should always strive to administer a prescribed medication, even if doing so may be difficult.
A young client has a temperature of 102℉ (38.9℃). In addition to the scheduled antipyretic the child received, the nurse is treating the fever with nonpharmacologic methods by removing the blanket that covers the child. What is the rationale for this action? Removing excess coverings allows for evaporation, which aids in cooling the child. The blanket soaks up the sweat, making the child warmer. The blanket adds heat to the child. Covering the child with a blanket leads to shivering, which will only generate more heat.
Removing excess coverings allows for evaporation, which aids in cooling the child. Explanation: Removing covering from a child when he or she is febrile aids in additional cooling by allowing evaporative heat loss. The rationale is not that the blanket warms the child further, or that it will soak up sweat. Nor will covering the child lead to shivering. Shivering occurs when the child is chilled by some intervention; shivering serves as a sign that the cooling procedure needs to be stopped.
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 ask the child nicely, "Will you drink this for me?" Tell the parent to tell the child, "It tastes just like candy!" Tell the parent to say calmly, "Can you drink this for me?" Tell the parent to state firmly, "It's time for you to drink your medicine."
Tell the parent to state firmly, "It's time for you to drink your medicine." Explanation: The best guideline for the parent to help in getting a child to take the liquid medication is to state firmly, "It's time to take your medication." Asking or pleading with the child does not work. Firmness is required. The child can be, however, allowed to choose what liquid to use to help swallow the medication. This helps with self-esteem and independence. The parent should also be honest about the taste of the medication. Adults also should never refer to medicine as candy. If a child happens to like a particular medicine, he or she may help themselves to it, and consuming too much can be fatal.
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? "It is standard policy in our facility to use a 5-ml syringe for all PICC line flushes." "Using a larger-volume syringe exerts less pressure on the PICC line." "I like how the 5-ml syringe fits in my hand. I feel like I have a better grip on it than a smaller syringe." "The 5-ml syringe is what we have the most stock of so I just always use it."
"Using a larger-volume syringe exerts less pressure on the PICC line." Explanation: Using a larger-volume syringe (i.e., 5 mL or larger) exerts less pressure on the PICC, thereby reducing the risk of rupture.
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 deltoid muscle with a 20-gauge needle. Administer the medication in the neonate's vastus lateralis with a 25-gauge needle. Administer the medication in the vastus lateralis with a 20-gauge needle. Administer the medication in the dorsogluteal with a 25-gauge needle.
Administer the medication in the neonate's vastus lateralis with a 25-gauge needle. Explanation: The vastus lateralis site is a safe choice for intramuscular (IM) injections in a neonate. A 22- to 25-gauge needle is recommended for neonates, but the nurse must assess the neonate's size before determining needle size to use. The 25-gauge needle is recommended for neonates. The dorsogluteal site should not be used until school age. Neither the deltoid muscle nor the dorsogluteal muscle are recommended IM sites for neonates. These muscles should not be used until toddler age or older. The volume of the medication should not exceed 0.5 ml per injection until the child is preschool age.
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 if it is okay to give the injection now. Ask the child where the child would like to have the injection. Announce to the child that it is time for insulin and give the injection matter-of-factly. Tell the child that the client is to remain very still and not cry.
Ask the child where the child would like to have the injection. Explanation: Asking the client to choose where to receive the injection gives a degree of control. Announcing that it is time for the medication does not give any sense of control to the child. Asking permission to give a medication to a child is not appropriate—a child should not be given the opportunity to decline a medication. It is not appropriate to tell a child not to cry during a painful procedure. The child should be given permission to yell out or cry if he or she feels the need to.
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? "After administering the drops, I will ask my child to remain side-lying for several minutes." "After removing the medication from the refrigerator, I need to roll it gently in my palms to warm it." "I will hold the dropper 0.5 in (1.25 cm) above the ear canal and be certain not to touch the ear with the dropper." "I will pull the outer ear down and back before administering the medication."
"I will pull the outer ear down and back before administering the medication." Explanation: The proper technique to instill ear drops in a child older than 3 years of age involves pulling the pinna up and back. Otic medication should not be administered if it is cold. Cold medication may cause discomfort and produce vomiting or vertigo in the child. If an otic medication must be refrigerated, it should be warmed in the palms of the hands. Proper otic administration technique involves holding the dropper 0.5 in (1.25 cm) above the ear canal and being careful not to touch the dropper to the ear to prevent contamination of the dropper with microorganisms. The child should remain in a side-lying (or supine) position for several minutes after administration.
A 5-year-old client is scheduled to have an influenza injection before being discharged from the hospital. When the nurse explains what she has to do, the client begins to cry and asks the nurse if she can have the shot after her movie is over in 2 hours. Which response by the nurse would be the best choice for the client? Agree to postpone the injection until after the movie is done. Negotiate with the child to give the injection in 1 hour. Offer to contact the pediatrician's office to have it given at the next visit. Tell the child that you need to give her the injection now.
Tell the child that you need to give her the injection now. Explanation: Children often try to postpone frightening or painful procedures by stalling. The nurse needs to take responsibility for making the decisions of care and when and what needs to be done. In this case, the best response would be to tell the client that you need to give the injection now and get it over with. Postponing events that the child dreads only heightens their anxiety.
The nurse is caring for a breastfed infant hospitalized for gastroenteritis. Which method can be used to most accurately measure intake? Document breastfeeding for elapsed time the baby feeds It is impossible to get an accurate intake measurement. Estimate based on comparison with bottle-fed infants. Weigh the infant before and after feeding and subtract weight.
Weigh the infant before and after feeding and subtract weight. Explanation: Intake in breast-fed infants is generally recorded as "breast-fed for X minutes." If it is necessary to estimate the amount more closely than this, an infant can be weighed before and after a feeding. The difference in weight (measured in grams) is calculated to establish the number of milliliters of breast milk ingested (1 g = 1 ml). Weighing the infant before and after feeding is the most accurate method for strict intake. Comparing to a bottle-fed infant is inaccurate and therefore not correct.
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." "The doctor wants to see if you have strep throat." "The doctor needs to take your blood to see why you are sick." "The doctor needs to use a needle and a little container to get blood to see if you have strep."
"The doctor will look at your blood to see why you are sick." Explanation: The nurse should provide a description of and reason for the procedure in age-appropriate language. The nurse should avoid the use of terms such as culture or strep throat, as it is not age-appropriate for a 4-year-old child. The nurse should also avoid confusing terms like "take your blood" that might be interpreted literally.
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? 28.0 mg per dose 40.8 mg per dose 250 mg per dose 375 mg per dose
375 mg per dose Explanation: One kilogram equals 2.2 lb.; therefore, a child weighing 75 lb weighs 34 kg. The low dose of this medication would be 34 X 33 = 1122 divided by 4 times a day equals 280.5 mg per dose. The high dose of this medication would be 34 X 48 = 1632 divided by 4 times a day equals 408 mg per dose. Therefore, a dose of 375 mg per dose would be appropriate.
A child is reporting pain where an IV infiltrated his hand earlier in the shift. The doctor orders warm compresses to the right hand every 4 hours. What precautions would the nurse implement for this client? Heat the moistened towels in the microwave. Use hot water on gauze for the warm compress. Limit treatments to 20 minutes at a time. Have the parents apply the warm compresses if the nurse is tied up elsewhere.
Limit treatments to 20 minutes at a time. Explanation: Warm compresses are used to increase circulation to an area of the body and to promote pain relief. For a child having warm compresses, the length of each session is a maximum of 20 minutes to prevent skin damage. Towels used in warm compresses are never heated in a microwave because of uneven heating. Parents are not to apply compresses because the nurse needs to assess the skin before and after the treatment. Gauze is not a good material for compresses; it does not hold heat well.
The health care provider orders a urinalysis on a 15-month-old toddler. The mother states that the child is not potty-trained. What is the best way for the nurse to collect the specimen? Aspirate urine out of the diaper with a syringe and place it in a specimen cup. Place a urine collection bag on the child after cleaning off the perineum. Clean off the penis with a commercial cleaning pad and catheterize the client. Observe the child for signs he needs to urinate and quickly pull the diaper down and catch the urine when he voids.
Place a urine collection bag on the child after cleaning off the perineum. Explanation: In clients that are not potty-trained, the best method for collecting a urine specimen is to place a urine collection bag on the child and wait for them to void. The doctor did not order a urine culture, so a catheterized urinalysis is not needed and would be traumatic for the child. Trying to catch urine from a voiding toddler is nearly impossible. Aspirating urine out of the diaper is not the best approach or one that ensures the best results.
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." "Mixing the medication with milk will help." "Give the medication until your child has no symptoms." "Crush the pills and mix with applesauce when giving the medication."
"Use a dosing cap to measure the dosage." Explanation: When talking to parents about giving medicine, stress that if a medicine comes supplied with a dosing cap, it is best to use that to measure the correct dose (Pham et al., 2011). If there is no dosing cap, then an oral medicine syringe or dropper are the next best methods to measure liquid medicine because kitchen teaspoons are rarely exactly 5 ml. Antibiotics need to be taken for the full course, not until symptoms subside. Mixing the medication with a drink or in food makes it difficult to determine how much the child has taken if the child refuses to finish it all. Amoxicillin comes in a liquid form, so crushing the pills is not appropriate.
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 port in the left upper chest An intraosseous line in the left lower leg A peripherally inserted central catheter (PICC) line in an antecubital space A Hickman catheter in the right upper chest
A peripherally inserted central catheter (PICC) line in an antecubital space Explanation: If IV antibiotic therapy is going to be needed for an extended period of time, a type of longer-term device needs to be used as opposed to a peripheral IV. A peripheral IV would need to be changed often and the risks of dislodgement or inflammation are much greater. Peripherally inserted central catheters (PICCs) are placed in the upper arm under ultrasound guidance. If maintained properly they can remain for many months. This means no IV sticks for the time the child would need IV therapy. It also leaves the hands free to use. A port must be surgically implanted into the child's chest. It can remain for many months. This would not be warranted for a one-time treatment of antibiotic therapy. A Hickman catheter is inserted via sterile procedure by a surgeon. This catheter is placed near the heart and has an increased risk of infection. An intraosseous line is not a route for long-term administration. It is used for emergent situations.
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 Place the prescribed number of drops into the lower eyelid Wipe any excess medication from the skin Retract the lower conjunctival sac Instruct the child to gently close the eyes
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 Explanation: After performing the rights of medication administration, the nurse would place the child in the supine position, slightly hyperextending the neck with the head lower than the body. Next, the nurse would retract the lower eyelid and instill the drops. The child would then gently close the eyes and the nurse would remove any excess medication.
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: ask the child to state his or her name. tell the child to state his or her nickname. call the child's name and see if he or she answers. read the child's armband.
read the child's armband. Explanation: A child may answer to the wrong name or deny his or her identity to avoid an unpleasant situation or if scared of the unknown. If the child is avoiding the situation he or she may fail to answer. Using the child's nickname is okay in conversation but it is not a legal identification of the child. To verify the correct identity the nurse should verify the child's armband and the correct name with the child's caregiver. Bar code scanning the child's armband would also be a correct method of identification.
The nurse is preparing to administer albuterol to a 14-year-old client for the first time. Prior to administration, which adverse reaction is priority for the nurse to educate the client? tachycardia hypoactivity increased appetite bronchial muscle relaxation
tachycardia Explanation: Adverse reactions of albuterol, a bronchodilator, include tachycardia, nervousness, tremors, hyperactivity, malaise, palpitations, increased appetite, hypokalemia, and muscle cramps. The expected action of albuterol is to relax bronchial, uterine, and vascular smooth muscle by stimulating beta-2 receptors. While tachycardia and increased appetite are both adverse reactions, tachycardia happens abruptly following the first dose and can be alarming for clients. It is a priority for the nurse to provide education on this over a slower, less concerning change.
