PEDS CHAP #4 & 5
A burn patient is experiencing anxiety over dressing changes. Which prescription should the nurse expect to be ordered to control anxiety? A. Lorazepam (Ativan) B. Oxycodone (OxyContin) C. Fentanyl (Sublimaze) D. Morphine Sulfate (Morphine)
ANS: A A benzodiazepine such as lorazepam is prescribed as an antianxiety agent. Oxycodone, fentanyl, and morphine sulfate are opioid analgesics.
A child receiving morphine sulfate (Morphine) is experiencing respiratory depression. A health care provider prescribes naloxone (Narcan), 0.5 mcg/kg IV in 2-minute increments until breathing improves. The medication label states: "Naloxone 400 mcg/1 mL." The child weighs 40 kg. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using two decimal places.
ANS: 0.05 Follow the formula for dosage calculation. Multiply 0.5 mcg × 40 kg to get the dose = 20 mcg Desired × Volume = mL per dose Available 20mcg ×1mL=0.05mL
A health care provider prescribes promethazine (Phenergan), 9 mg IV every 6 to 8 hr as needed for pruritus. The medication label states: "Promethazine 25 mg/1 mL." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer using two decimal places.________________
ANS: 0.36 Follow the formula for dosage calculation. Desired × Volume = mL per dose Available 9mg ×1mL=0.36mL
A health care provider prescribes Kytril (granisetron), 10 mcg/kg IV every 4 to 6 hr as needed for nausea. The medication label states: "Kytril 100 mcg/1 mL." The child weighs 15 kg. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer to one decimal place._______________
ANS: 1.5 Follow the formula for dosage calculation. Multiply 10 mcg × 15 kg to get the dose = 150 mcg Desired × Volume = mL per dose Available 150 mcg × 1 mL = 1.5 mL
A health care provider prescribes diphenhydramine (Benadryl), 1 mg/kg PO every 4 to 6 hr as needed for pruritus. The child weighs 10 kg. The medication label states: "Diphenhydramine 12.5 mg/5 mL." The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number. ________________
ANS: 4 Follow the formula for dosage calculation. Multiply 1 mg × 10 kg to get the dose = 10 mg Desired × Volume = mL per dose Available 10mg ×5mL = 4mL 12.5mg
A health care provider prescribes hydroxyzine (Atarax), 0.6 mg/kg PO every 4 to 6 hr as needed for pruritus. The medication label states: "Hydroxyzine 10 mg/5 mL." The child weighs 20 kg. The nurse prepares to administer one dose. How many milliliters will the nurse prepare to administer one dose? Fill in the blank. Record your answer in a whole number.________________
ANS: 6 Follow the formula for dosage calculation. Multiply 0.6 mg × 20 kg to get the dose = 12 mg Desired × Volume = mL per dose Available 12 mg × 5 mL = 6 mL 10 mg
Children as young as age 3 years can use facial scales for discrimination. What are some suggested anchor words for the preschool age-group? A. "No hurt." B. "Red pain." C. "Zero hurt." D. "Least pain."
ANS: A "No hurt" is a phrase that is simple, concrete, and appropriate to the preoperational stage of the child. Using color is complicated for this age-group. The child needs to identify colors and pain levels and then choose an appropriate symbolic color. This is appropriate for an older child. Zero is an abstract construct not appropriate for this age-group. "Least pain" is less concrete than "no hurt."
During a funduscopic examination of a school-age child, the nurse notes a brilliant, uniform red reflex in both eyes. The nurse should recognize that this is which? A. A normal finding B. A sign of a possible visual defect and a need for vision screening C. An abnormal finding requiring referral to an ophthalmologist D. A sign of small hemorrhages, which usually resolve spontaneously
ANS: A A brilliant, uniform red reflex is an important normal finding. It rules out many serious defects of the cornea, aqueous chamber, lens, and vitreous chamber.
What describes nonpharmacologic techniques for pain management? A. They may reduce pain perception. B. They usually take too long to implement. C. They make pharmacologic strategies unnecessary. D. They trick children into believing they do not have pain.
ANS: A Nonpharmacologic techniques provide coping strategies that may help reduce pain perception, make the pain more tolerable, decrease anxiety, and enhance the effectiveness of analgesics. The nonpharmacologic strategy should be matched with the child's pain severity and be taught to the child before the onset of the painful experience. Tricking children into believing they do not have pain may mitigate the child's experience with mild pain, but the child will still know the discomfort was present.
Which is a complication that can occur after abdominal surgery if pain is not managed? A. Atelectasis B. Hypoglycemia C. Decrease in heart rate D. Increase in cardiac output
ANS: A Pain associated with surgery in the abdominal region (e.g., appendectomy, cholecystectomy, splenectomy) may result in pulmonary complications. Pain leads to decreased muscle movement in the thorax and abdominal area and leads to decreased tidal volume, vital capacity, functional residual capacity, and alveolar ventilation. The patient is unable to cough and clear secreti ons, and the risk for complications such as pneumonia and atelectasis is high. Severe postoperative pain also results in sympathetic overactivity, which leads to increases in heart rate, peripheral resistance, blood pressure, and cardiac output. Hypoglycemia, decreases in heart rate, and increases in cardiac output are not complications of poor pain management.
Which is the most frequently used test for measuring visual acuity? A. Snellen letter chart B. Ishihara vision test C. Allen picture card test D. Denver eye screening test
ANS: A The Snellen letter chart, which consists of lines of letters of decreasing size, is the most frequently used test for visual acuity. The Ishihara vision test is used for color vision. The Allen picture card test and Denver eye screening test involve single cards for children ages 2 years and older who are unable to use the Snellen letter chart.
The nurse is caring for a child receiving a continuous intravenous (IV) low-dose infusion of morphine for severe postoperative pain. The nurse observes a slower respiratory rate, and the child cannot be aroused. The most appropriate management of this child is for the nurse to do which first? A. Discontinue infusion and administer naloxone (Narcan). B. Direct the charge nurse to call a Code Blue. C. Discontinue morphine until the child is fully awake. D. Document clinical findings.
ANS: A The management of opioid-induced respiratory depression includes lowering the rate of infusion and stimulating the child. If the respiratory rate is depressed and the child cannot be aroused, then IV naloxone should be administered. The child will be in pain because of the reversal of the morphine. The morphine should be discontinued, but naloxone is indicated if the child is unresponsive.
The nurse's approach when introducing hospital equipment to a preschooler who seems afraid should be based on which principle? A. The child may think the equipment is alive. B. Explaining the equipment will only increase the child's fear. C. One brief explanation will be enough to reduce the child's fear. D. The child is too young to understand what the equipment does.
ANS: A Young children attribute human characteristics to inanimate objects. They often fear that the objects may jump, bite, cut, or pinch all by themselves without human direction. Equipment should be kept out of sight until needed. Simple, concrete explanations about what the equipment does and how it will feel will help alleviate the child's fear. Preschoolers need repeated explanations as reassurance.
The nurse is performing an oral examination on a preschool child. Which strategies should the nurse use to encourage the child to open the mouth for the examination? (Select all that apply.) A. Lightly brush the palate with a cotton swab. B. Perform the examination in front of a mirror. C. Let the child examine someone else's mouth first. D. Have the child breathe deeply and hold his or her breath. E. Use a tongue blade to help the child open his or her mouth.
ANS: A, B, C, D To encourage a child to open the mouth for examination, the nurse can lightly brush the palate with a cotton swab, perform the examination in front of a mirror, let the child examine someone else's mouth first, and have the child breathe deeply and hold his or her breath. A tongue blade may elicit the gag reflex and should not be used.
Additional biobehavioral interventions may be helpful in reducing pain. Which of the following may be considered? (Select all that apply.) A. Transcutaneous nerve stimulation B. Distraction C. Steroidal treatment D. Percutaneous nerve ablation E. Cognitive-behavioral therapy
ANS: A, B, E Biobehavioral interventions prevent and treat pain by interrupting the pain, fear, anxiety, and stress cycle. Distraction, relaxation, guided imagery, hypnosis, CBT, massage, heat, cold, and transcutaneous nerve stimulation can help with pain control. Steroids are a pharmacologic treatment for inflammatory disorders, and the percutaneous nerve ablation is a minimally invasive procedure often seen for lower lumbar disorders.
The nurse understands that blocks to therapeutic communication include what? (Select all that apply.) A. Socializing B. Use of silence C. Using clichés D. Defending a situation E. Using open-ended questions
ANS: A, C, D Blocks to communication include socializing, using clichés, and defending a situation. Use of silence and using open-ended questions are therapeutic communication techniques.
The nurse is assessing heart sounds on a school-age child. Which should the nurse document as abnormal findings if found on the assessment? (Select all that apply.) A. S4 heart sound B. S3 heart sound C. Grade II murmur D. S1 louder at the apex of the heart E. S2 louder than S1 in the aortic area
ANS: A, C, E S4 is rarely heard as a normal heart sound; it usually indicates the need for further cardiac evaluation. A grade II murmur is not normal; it is slightly louder than grade I and is audible in all positions. S3 is normally heard in some children. Normally, S1 is louder at the apex of the heart in the mitral and tricuspid area, and S2 is louder near the base of the heart in the pulmonic and aortic area
When the nurse interviews an adolescent, which is especially important? A. Focus the discussion on the peer group. B. Allow an opportunity to express feelings. C. Use the same type of language as the adolescent. D. Emphasize that confidentiality will always be maintained.
ANS: B Adolescents, like all children, need opportunities to express their feelings. Often, they interject feelings into their words. The nurse must be alert to the words and feelings expressed. The nurse should maintain a professional relationship with adolescents. To avoid misunderstanding or misinterpretation of words and phrases used, the nurse should clarify the terms used, what information will be shared with other members of the health care team, and any limits to confidentiality. Although the peer group is important to this age-group, the interview should focus on the adolescent.
A cancer patient is experiencing neuropathic cancer pain. Which prescription should the nurse expect to be ordered? A. Lorazepam (Ativan) B. Gabapentin (Neurontin) C. Hydromorphone (Dilaudid) D. Morphine sulfate (MS Contin)
ANS: B Anticonvulsants (gabapentin, carbamazepine) have demonstrated effectiveness in neuropathic cancer pain. Ativan is an antianxiety agent, and Dilaudid and MS Contin are opioid analgesics.
Which is the most consistent and commonly used data for assessment of pain in infants? A. Self-report B. Behavioral C. Physiologic D. Parental report
ANS: B Behavioral assessment is useful for measuring pain in young children and preverbal children who do not have the language skills to communicate that they are in pain. Infants are not able to self-report. Physiologic measures are not able to distinguish between physical responses to pain and other forms of stress. Parental report without a structured tool may not accurately reflect the degree of discomfort.
The nurse has just started assessing a young child who is febrile and appears ill. There is hyperextension of the child's head (opisthotonos) with pain on flexion. Which is the most appropriate action? A. Ask the parent when the neck was injured. B. Refer for immediate medical evaluation. C. Continue assessment to determine the cause of the neck pain. D. Record "head lag" on the assessment record and continue the assessment of the child.
ANS: B Hyperextension of the child's head with pain on flexion is indicative of meningeal irritation and needs immediate evaluation. No indication of injury is present. This situation is not descriptive of head lag.
The parents of a preterm infant in a neonatal intensive care unit are concerned about their infant experiencing pain from so many procedures. The nurse's response should be based on which characteristic about preterm infants' pain? A. They may react to painful stimuli but are unable to remember the pain experience. B. They may perceive and react to pain in much the same manner as children and adults. C. They do not have the cortical and subcortical centers that are needed for pain perception. D. They lack neurochemical systems associated with pain transmission and modulation.
ANS: B Numerous research studies have indicated that preterm and newborn infants perceive and react to pain in the same manner as children and adults. Preterm infants can have significant reactions to painful stimuli. Pain can cause oxygen desaturation and global stress response. These physiologic effects must be avoided by use of appropriate analgesia. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response.
What is the earliest age at which a satisfactory radial pulse can be taken in children? A. 1 year B. 2 years C. 3 years D. 6 years
ANS: B Satisfactory radial pulses can be taken in children older than 2 years. In infants and young children, the apical pulse is more reliable.
What is an important consideration when using the FACES pain rating scale with children? A. Children color the face with the color they choose to best describe their pain. B. The scale can be used with most children as young as 3 years. C. The scale is not appropriate for use with adolescents. D. The FACES scale is useful in pain assessment but is not as accurate as physiologic responses.
ANS: B The FACES scale is validated for use with children ages 3 years and older. Children point to the face that best describes their level of pain. The scale can be used through adulthood. The child's estimate of the pain should be used. The physiologic measures may not reflect more long-term pain.
Which drug is usually the best choice for patient-controlled analgesia (PCA) for a child in the immediate postoperative period? A. Codeine sulfate (Codeine) B. Morphine (Roxanol) C. Methadone (Dolophine) D. Meperidine (Demerol)
ANS: B The most commonly prescri bed medications for PCA are morphine, hydromorphone, and fentanyl. Parenteral use of codeine is not recommended. Methadone in parenteral form is not used in a PCA but is given orally or intravenously for pain in the infant. Meperidine is not used for continuous and extended pain relief.
What is the appropriate placement of a tongue blade for assessment of the mouth and throat? A. On the lower jaw B. Side of the tongue C. Against the soft palate D. Center back area of the tongue
ANS: B The side of the tongue is the correct position. It avoids the gag reflex yet allows visualization. On the lower jaw and against the soft palate are not appropriate places for the tongue blade. Placement in the center back area of the tongue elicits the gag reflex.
The nurse is performing an otoscopic examination on a child. Which are normal findings the nurse should expect? (Select all that apply.) A. Ashen gray areas B. A well-defined light reflex C. A small, round, concave spot near the center of the drum D. The tympanic membrane is a nontransparent grayish color E. A whitish line extending from the umbo upward to the margin of the membrane
ANS: B, C, E Normal findings include the light reflex and bony landmarks. The light reflex is a well-defined, cone-shaped reflection that normally points away from the face. The bony landmarks of the eardrum are formed by the umbo, or tip of the malleus. It appears as a small, round, opaque, concave spot near the center of the eardrum. The manubrium (long process or handle) of the malleus appears to be a whitish line extending from the umbo upward to the margin of the membrane. The tympanic membrane should be light pearly pink or gray and translucent, not nontransparent. Ashen gray areas indicate signs of scarring from a previous perforation.
When auscultating an infant's lungs, the nurse detects diminished breath sounds. What should the nurse interpret this as? A. Suggestive of chronic pulmonary disease B. Suggestive of impending respiratory failure C. An abnormal finding warranting investigation D. A normal finding in infants younger than 1 year of age
ANS: C Absent or diminished breath sounds are always an abnormal finding. Fluid, air, or solid masses in the pleural space all interfere with the conduction of breath sounds. Further data are necessary for diagnosis of chronic pulmonary disease or impending respiratory failure. Diminished breath sounds in certain segments of the lungs can alert the nurse to pulmonary areas that may benefit from chest physiotherapy. Further evaluation is needed in all age-groups.
With the National Center for Health Statistics criteria, which body mass index (BMI)-for-age percentiles should indicate the patient is at risk for being overweight? A. 10th percentile B. 75th percentile C. 85th percentile D. 95th percentile
ANS: C Children who have BMI-for-age greater than or equal to the 85th percentile and less than the 95th percentile are at risk for being overweight. Children who are greater than or equal to the 95th percentile are considered overweight. Children whose BMI is between the 10th and 75th percentiles are within normal limits.
What is a significant common side effect that occurs with opioid administration? A. Euphoria B. Diuresis C. Constipation D. Allergic reactions
ANS: C Constipation is one of the most common side effects of opioid administration. Preventive strategies should be implemented to minimize this problem. Sedation is a more common result than euphoria. Urinary retention, not diuresis, may occur with opiates. Rarely, some individuals may have pruritus.
A child is in the intensive care unit after a motor vehicle collision. The child has numerous fractures and is in pain that is rated 9 or 10 on a 10-point scale. In planning care, the nurse recognizes that the indicated action is which? A. Give only an opioid analgesic at this time. B. Increase dosage of analgesic until the child is adequately sedated. C. Plan a preventive schedule of pain medication around the clock. D. Give the child a clock and explain when she or he can have pain medications.
ANS: C For severe postoperative pain, a preventive around the clock (ATC) schedule is necessary to prevent decreased plasma levels of medications. The opioid analgesic will help for the present, but it is not an effective strategy. Increasing the dosage requires an order. The nurse should give the drug on a regular schedule and evaluate the effectiveness. Using a clock is counterproductive because it focuses the child's attention on how long he or she will need to wait for pain relief.
Which heart sound is produced by vibrations within the heart chambers or in the major arteries from the back-and-forth flow of blood? A. S1 and S2 B. S3 and S4 C. Murmur D. Physiologic splitting
ANS: C Murmurs are the sounds that are produced in the heart chambers or major arteries from the back-and-forth flow of blood. S1 and S2 are normal heart sounds. S1 is the closure of the tricuspid and mitral valves, and S2 is the closure of the pulmonic and aortic valves. S3 is a normal heart sound sometimes heard in children. S4 is rarely heard as a normal heart sound. If it is heard, medical evaluation is required. Physiologic splitting is the distinction of the two sounds in S2, which widens on inspiration. It is a significant normal finding.
The nurse is planning to administer a nonopioid for pain relief to a child. Which timing should the nurse plan, so the nonopioid takes effect? A. 15 minutes until maximum effect B. 30 minutes until maximum effect C. 1 hr until maximum effect D. 1 1/2 hr until maximum effect
ANS: C Nonsteroidal anti-inflammatory drugs (NSAIDs) can provide safe and effective pain relief when dosed at appropriate levels with adequate frequency. Most NSAIDs take about 1 hr for effect, so timing is crucial.
Where is the best place to observe for the presence of petechiae in dark-skinned individuals? A. Face B. Buttocks C. Oral mucosa D. Palms and soles
ANS: C Petechiae, small distinct pinpoint hemorrhages, are difficult to see in dark-skinned individuals unless they are in the mouth or conjunctiva.
What is an appropriate screening test for hearing that the nurse can administer to a 5-year-old child? A. Rinne test B. Weber test C. Pure tone audiometry D. Eliciting the startle reflex
ANS: C Pure tone audiometry uses an audiometer that produces sounds at different volumes and pitches in the child's ears. The child is asked to respond in some way when the tone is heard in the earphone. The Rinne and Weber tests measure bone conduction of sound. Eliciting the startle reflex may be useful in infants.
During a routine health assessment, the nurse notes that an 8-month-old infant has a significant head lag. Which is the most appropriate action? A. Recheck head control at next visit. B. Teach the parents appropriate exercises. C. Schedule the child for further evaluation. D. Refer the child for further evaluation if the anterior fontanel is still open.
ANS: C Significant head lag after age 6 months strongly indicates cerebral injury and is referred for further evaluation. Head control is part of normal development. Exercises will not be effective. The lack of achievement of this developmental milestone must be evaluated.
A 6-year-old child has patient-controlled analgesia (PCA) for pain management after orthopedic surgery. The parents are worried that their child will be in pain. What should your explanation to the parents include? A. The child will continue to sleep and be pain free. B. Parents cannot administer additional medication with the button. C. The pump can deliver baseline and bolus dosages. D. There is a high risk of overdose, so monitoring is done every 15 minutes.
ANS: C The PCA prescription can be set for a basal rate for a continuous infusion of pain medication. Additional doses can be administered by the patient, parent, or nurse as necessary. Although the goal of PCA is to have effective pain relief, a pain-free state may not be possible. With a 6-year-old child, the parents and nurse must assess the child to ensure that adequate medication is being given because the child may not understand the concept of pushing a button. Evidence-based practice suggests that effective analgesia can be obtained with the parents and nurse giving boluses as necessary. The prescription for the PCA includes how much medication can be given in a defined period. Monitoring every 1 to 2 hr for patient response is sufficient.
1. Which is the single most important factor to consider when communicating with children? A. Presence of the child's parent B. Child's physical condition C. Child's developmental level D. Child's nonverbal behaviors
ANS: C The nurse must be aware of the child's developmental stage to engage in effective communication. The use of both verbal and nonverbal communication should be appropriate to the developmental level. Nonverbal behaviors vary in importance based on the child's developmental level and physical condition. Although the child's physical condition is a consideration, developmental level is much more important. The presence of parents is important when communicating with young children but may be detrimental when speaking with adolescents.
The nurse is testing an infant's visual acuity. By which age should the infant be able to fix on and follow a target? A. 1 month B. 1 to 2 months C. 3 to 4 months D. 6 months
ANS: C Visual fixation and ability to follow a target should be present by ages 3 to 4 months. One to two months is too young for this developmental milestone. If an infant is not able to fix and follow by 6 months, further ophthalmologic evaluation is needed.
Which are components of the FLACC scale? (Select all that apply.) A. Color B. Capillary refill time C. Leg position D. Facial expression E. Activity
ANS: C, D, E Facial expression, consolability, cry, activity, and leg position are components of the FLACC scale. Color is a component of the Apgar scoring system. Capillary refill time is a physiologic measure that is not a component of the FLACC scale.
The nurse is assessing breath sounds on a child. Which are expected auscultated breath sounds? (Select all that apply.) a. Wheezes b. Crackles c. Vesicular d. Bronchial e. Bronchovesicular
ANS: C, D, E Normal breath sounds are classified as vesicular, bronchovesicular, or bronchial. Wheezes or crackles are abnormal or adventitious sounds.
The nurse is assessing a child's capillary refill time. This can be accomplished by doing what? A. Inspect the chest. B. Auscultate the heart. C. Palpate the apical pulse. D. Palpate the nail bed with pressure to produce a slight blanching.
ANS: D Capillary refill time is assessed by pressing lightly on the skin to produce blanching and then noting the amount of time it takes for the blanched area to refill. Inspecting the chest, auscultating the heart, and palpating the apical pulse will not provide an assessment of capillary refill time.
During examination of a toddler's extremities, the nurse notes that the child is bowlegged. The nurse should recognize that this finding is which? A. Abnormal and requires further investigation. B. Abnormal unless it occurs in conjunction with knock-knee. C. Normal if the condition is unilateral or asymmetric. D. Normal because the lower back and leg muscles are not yet well developed.
ANS: D Lateral bowing of the tibia (bowlegged) is an expected finding in toddlers when they begin to walk. It usually persists until all their lower back and leg muscles are well developed. Further evaluation is needed if it persists beyond ages 2 to 3 years, especially in African American children.
A preterm infant has just been admitted to the neonatal intensive care unit and will undergo numerous painful procedures. The infant's parents ask the nurse about pain in the neonate and further asked about anesthesia for these procedures. What should the nurse's explanation be? A. Nerve pathways of neonates are not sufficiently myelinated to transmit painful stimuli. B. The risks accompanying anesthesia and analgesia are too great to justify any possible benefit of pain relief. C. Neonates do not possess sufficiently integrated cortical function to interpret or recall pain experiences. D. Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates and should be considered when giving care.
ANS: D Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates. Painful stimuli cause a global stress response, including cardiorespiratory changes, palmar sweating, increased intracranial pressure, and hormonal and metabolic changes. Adequate analgesia and anesthesia are necessary to decrease the stress response. The pathways are sufficiently myelinated to transmit the painful stimuli and produce the pain response. Local and systemic pharmacologic agents are available to permit anesthesia and analgesia for neonates
Which nonpharmacologic intervention appears to be effective in decreasing needlestick pain? A. Tactile stimulation B. Commercial warm packs C. Doing procedure during infant sleep D. Oral sucrose or breastfeeding
ANS: D Sucking attenuates behavioral, physiologic, and hormonal responses to pain. The addition of sucrose has been demonstrated to have calming and pain-relieving effects for infants. Tactile stimulation has a variable effect on response to procedural pain. No evidence supports commercial warm packs as a pain control measure. With resulting increased blood flow to the area, pain may be greater. The infant should not be disturbed during the sleep cycle. It makes it more difficult for the infant to begin organization of sleep and awake cycles.
The nurse is planning pain control for a child. Which is the advantage of administering pain medication by the intravenous (IV) bolus route? A. Less expensive than oral medications. B. Produces a first-pass effect through the liver. C. Does not need to be administered frequently. D. Provides most rapid onset of effect, usually in about 5 minutes.
ANS: D The advantage of pain medication by the IV bolus route is that it provides the most rapid onset of effect, usually in about 5 minutes. IV medications are more expensive than oral medications, and the IV route bypasses the first-pass effect through the liver. Pain control with IV bolus medication needs to be repeated hourly for continuous pain control.
Examination of the abdomen is performed correctly by the nurse in which order? A. Inspection, palpation, percussion, and auscultation B. Inspection, percussion, auscultation, and palpation C. Palpation, percussion, auscultation, and inspection D. Inspection, auscultation, percussion, and palpation
ANS: D The correct order of abdominal examination is inspection, auscultation, percussion, and palpation. Palpation is always performed last because it may distort the normal abdominal sounds. Auscultation is performed before percussion. The act of percussion can influence the findings on auscultation.
Which parameter correlates best with measurements of total muscle mass? A. Height B. Weight C. Skinfold thickness D. Upper arm circumference
ANS: D Upper arm circumference is correlated with measurements of total muscle mass. Muscle serves as the body's major protein reserve and is considered an index of the body's protein stores. Height is reflective of past nutritional status. Weight is indicative of current nutritional status. Skinfold thickness is a measurement of the body's fat content.
The nurse is teaching a staff development program about levels of sedation in the pediatric population. Which statement by one of the participants should indicate a correct understanding of the teaching? A. "With minimal sedation, the patient's respiratory efforts are affected, and cognitive function is not impaired." B. "With general anesthesia, the patient's airway cannot be maintained, but cardiovascular function is maintained." C. "During deep sedation, the patient can be easily aroused by loud verbal commands and tactile stimulation." D. "During moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation."
ANS: D When discussing levels of sedation, the participants should understand that during moderate sedation, the patient responds to verbal commands but may not respond to light tactile stimulation, cognitive function is impaired, and respiratory function is adequate. In minimal sedation, the patient responds to verbal commands and may have impaired cognitive function; the respiratory and cardiovascular systems are unaffected. In deep sedation, the patient cannot be easily aroused except by painful stimuli; the airway and spontaneous ventilation may be impaired, but cardiovascular function is maintained. With general anesthesia, the patient loses consciousness and cannot be aroused with painful stimuli, the airway cannot be maintained, and ventilation is impaired; cardiovascular function may or may not be impaired.