Wong's 11th ed - Chapter 20: Pediatric Nursing Interventions and Skills

A child with congestive heart failure is placed on a maintenance dosage of digoxin (Lanoxin). The dosage is 0.07 mg/kg/day, and the child's weight is 7.2 kg. The physician prescribes the digoxin to be given once a day by mouth. Each dose will be _____ milligrams. (Record your answer below using one decimal place.)

ANS: 0.5 Calculate the dosage by weight: 0.07 mg/day 7.2 kg = 0.5 mg/day.

A physician's prescription reads, "ampicillin sodium 125 mg IV every 6 hours." The medication label reads, "1 g = 7.4 ml." A nurse prepares to draw up _____ milliliters to administer one dose. (Round your answer to two decimal places.)

ANS: 0.93 Convert 1 g to milligrams. In the metric system, to convert larger to smaller, multiply by 1000 or move the decimal point three places to the right. 1 g = 1000 mg Formula: Desired Volume = 125 mg/1000 mg 7.4 ml = 0.925 round to 0.93 ml. Available

An infant is on strict intake and output and wears a diaper with a dry weight of 24 g. At the end of the shift, the infant has had two diapers with urine. One diaper weighed 56 g and one weighed 65 g. Which is the total milliliter output for the shift? _____ (Record your answer as a whole number below.)

ANS: 73 1 g of wet diaper weight = 1 ml of urine. The dry weight of the diaper is 24 g. 56 g - 24 g = 32 ml. 65 g - 24 g = 41 ml. 32 ml + 24 ml = 73 ml total output for the shift.

When liquid medication is given to a crying 10-month-old infant, which approach minimizes the possibility of aspiration? a. Administer the medication with an oral syringe placed along the side of the infant's tongue. b. Administer the medication as rapidly as possible with the infant securely restrained. c. Mix the medication with the infant's regular formula or juice and administer by bottle. d. Keep the child upright with the nasal passages blocked for a minute after administration.

ANS: A Administer the medication with a syringe without needle placed along the side of the infant's tongue. The contents are administered slowly in small amounts, allowing the child to swallow between deposits. Medications should be given slowly to avoid aspiration. The medication should be mixed with only a small amount of food or liquid. If the child does not finish drinking or eating, it is difficult to determine how much medication was consumed. Essential foods also should not be used. Holding the child's nasal passages will increase the risk of aspiration.

A 3-year-old child still has a fever of 102F, associated with a viral illness even after a dose of acetaminophen two hours ago. The nurse's action would be based on which statement? a. Fevers such as this are common with viral illnesses. b. Seizures are common in children when antipyretics are ineffective. c. Fever over 102 F indicates greater severity of illness. d. Fever over 102 F indicates a probable bacterial infection.

ANS: A Most fevers are of brief duration, with limited consequences, and are viral. Little evidence supports the use of antipyretic drugs to prevent febrile seizures. Neither the increase in temperature nor its response to antipyretics indicates the severity or etiology of infection.

When teaching a mother how to administer eye drops, where would the nurse tell her to place them? a. In the conjunctival sac that is formed when the lower lid is pulled down b. Carefully under the eye lid while it is gently pulled upward c. On the sclera while the child looks to the side d. Anywhere as long as drops contact the eye's surface

ANS: A The lower lid is pulled down, forming a small conjunctival sac. The solution or ointment is applied to this area. The medication should not be administered directly on the eyeball.

Urine testing for specific gravity and glucose are ordered on a 6-month-old infant, and the nurse will prepare for which action? a. Apply a urine-collection bag to the perineal area. b. Tape a small medicine cup to the inside of the diaper. c. Aspirate urine from cotton balls inside the diaper with a syringe. d. Aspirate urine from a superabsorbent disposable diaper with a syringe.

ANS: A To obtain small amounts of urine, use a syringe without a needle to aspirate urine directly from the diaper. If diapers with absorbent material are used, place a small gauze dressing or cotton balls inside the diaper to collect the urine, and aspirate the urine with a syringe. For frequent urine sampling, the collection bag would be too irritating to the child's skin. It is not feasible to tape a small medicine cup to the inside of the diaper; the urine will spill from the cup. Diapers with superabsorbent gels absorb the urine, so there is nothing to aspirate.

A nurse is caring for a child in droplet precautions. Which instructions would the nurse give to the unlicensed assistive personnel caring for this child? (Select all that apply.) a. Wear gloves when entering the room. b. Wear an isolation gown when entering the room. c. Place the child in a special air handling and ventilation room. d. A mask should be worn only when holding the child. e. Wash your hands upon exiting the room.

ANS: A, E Droplet transmission involves contact of the conjunctivae or the mucous membranes of the nose or mouth of a susceptible person with large-particle droplets (>5 mm) containing microorganisms generated from a person who has a clinical disease or who is a carrier of the microorganism. Droplets are generated from the source person primarily during coughing, sneezing, or talking and during procedures such as suctioning and bronchoscopy. Gloves, gowns, and a mask should be worn when entering the room. Hand washing when exiting the room should be done with any patient. Because droplets do not remain suspended in the air, special air handling and ventilation are not required to prevent droplet transmission.

A 2-year-old child comes to the emergency department with dehydration and hypovolemic shock. Which best explains why an intraosseous infusion is started? a. It is less painful for small children. b. Rapid venous access is not possible. c. Antibiotics must be started immediately. d. Long-term central venous access is not possible.

ANS: B In situations in which rapid establishment of systemic access is vital and venous access is hampered, such as peripheral circulatory collapse and hypovolemic shock, intraosseous infusion provides a rapid, safe, lifesaving alternative. The procedure is painful, and local anesthetics and systemic analgesics are given. Antibiotics could be given when vascular access is obtained. Long-term central venous access is time-consuming, and intraosseous infusion is used in an emergency situation.

In preparing to give "enemas until clear" to a young child, the nurse would select which solution? a. Tap water b. Normal saline c. Oil retention d. Fleet solution

ANS: B Isotonic solutions should be used in children. Saline is the solution of choice. Plain water is not used. This is a hypotonic solution and can cause rapid fluid shift, resulting in fluid overload. Oil-retention enemas will not achieve the "until clear" result. Fleet enemas are not advised for children because of the harsh action of the ingredients. The osmotic effects of the Fleet enema can result in diarrhea, which can lead to metabolic acidosis.

Which is considered an advantage of a Hickman-Broviac catheter? a. No need to keep exit site dry b. Easy to use for self-administered infusions c. Heparinized only monthly and after each infusion d. No limitations on regular physical activity, including swimming

ANS: B The Hickman-Broviac catheter has several benefits, including that it is easy to use for self-administered infusions. The exit site must be kept dry to decrease risk of infection. The Hickman-Broviac catheter requires daily heparin flushes. Water sports may be restricted because of risk of infection.

A child is receiving total parenteral nutrition, and at the end of 8 hours, the nurse notes that 200 ml/8 hr is being infused rather than the ordered amount of 300 ml/8 hr. The nurse would adjust the infusion to which rate during the next 8 hours? a. 200 ml b. 300 ml c. 350 ml d. 400 ml

ANS: B The TPN infusion rate should not be increased or decreased without the practitioner being informed because alterations in rate can cause hyperglycemia or hypoglycemia. Any changes from the prescribed flow rate may lead to hyperglycemia or hypoglycemia.

Which is an important nursing consideration when performing a bladder catheterization on a 10-year-old boy? a. Clean technique, not standard precautions, is needed. b. Insert 2% lidocaine lubricant on the meatus. c. Lubricate catheter with water-soluble lubricant such as K-Y Jelly. d. Delay catheterization for 20 minutes while anesthetic lubricant is absorbed.

ANS: B The anxiety, fear, and discomfort experienced during catheterization can be significantly decreased by preparation of the child and parents, by selection of the correct catheter, and by appropriate technique of insertion. Generous lubrication of the urethra before catheterization and use of lubricant containing 2% lidocaine may reduce or eliminate the burning and discomfort associated with this procedure. Catheterization is a sterile procedure, and standard precautions for body-substance protection should be followed. Water-soluble lubricants do not provide appropriate local anesthesia. Catheterization should be delayed 2 to 3 minutes only. This provides sufficient local anesthesia for the procedure.

A 7-year-old who is about to undergo a venipuncture wants her mother to hold her. Which information would the nurse include in her response to the child's request? a. It is unsafe. b. It is helpful to relax the child. c. It is against hospital policy. d. It is unnecessary because of child's age.

ANS: B The mother's preference for assisting, observing, or waiting outside the room should be assessed along with the child's preference for parental presence. The child's choice should be respected. This will most likely help the child through the procedure. If the mother and child agree, then the mother is welcome to stay. Her familiarity with the procedure should be assessed and potential safety risks identified (mother may sit in chair). Hospital policies should be reviewed to ensure that they incorporate family-centered care. The child should determine whether parental support is necessary.

Guidelines for intramuscular administration of medication in school-age children include which action? a. Inject medication as rapidly as possible. b. Insert needle quickly, using a dart like motion. c. Penetrate skin immediately after cleansing site, before skin has dried. d. Have child stand, if possible, and if child is cooperative.

ANS: B The needle should be inserted quickly in a dartlike motion at a 90-degree angle unless contraindicated. Inject medications slowly. Allow skin preparation to dry completely before skin is penetrated. Place child in lying or sitting position.

The advantages of the ventrogluteal muscle as an injection site in young children include which considerations? (Select all that apply.) a. Less painful than vastus lateralis b. Free of important nerves and vascular structures c. Cannot be used when child reaches a weight of 20 pounds d. Increased subcutaneous fat, which increases drug absorption e. Easily identified by well defined landmarks

ANS: B, E The advantages of the ventrogluteal are being less painful, free of important nerves and vascular lateralis, and easily identified by major landmarks. The major disadvantage is lack of familiarity by health professionals and controversy over whether the site can be used before weight bearing. The use of the ventrogluteal has not been clarified. It has been used in infants, but clinical guidelines address the need for the child to be walking, thus generally being over 20 pounds. The site has less subcutaneous tissue, which facilitates intramuscular (rather than subcutaneous) deposition of the drug.

The nurse must suction a child with a tracheostomy. Which is the appropriate technique? a. Encourage the child to cough to raise the secretions before suctioning. b. Select a catheter with diameter three-fourths as large as the diameter of the tracheostomy tube. c. Ensure each pass of the suction catheter would take no longer than 5 seconds. d. Allow the child to rest after every five times the suction catheter is passed.

ANS: C Suctioning should require no longer than 5 seconds per pass. Otherwise, the airway may be occluded for too long. If the child is able to cough up secretions, suctioning may not be indicated. The catheter should have a diameter one-half the size of the tracheostomy tube. If it is too large, it might block the child's airway. The child is allowed to rest for 30 to 60 seconds after each aspiration to allow oxygen tension to return to normal. Then the process is repeated until the trachea is clear.

The Allen test is performed as a precautionary measure before which procedure? a. Heel stick b. Venipuncture c. Arterial puncture d. Lumbar puncture

ANS: C The Allen test assesses the circulation of the radial, ulnar, or brachial arteries before arterial puncture. The Allen test is used before arterial punctures, not heel sticks, venipunctures, or lumbar punctures.

A critically ill child has hyperthermia. The parents ask the nurse to give an antipyretic such as acetaminophen (Tylenol). Which would the nurse explain about antipyretics? a. They may cause malignant hyperthermia b. They may cause febrile seizures c. They are of no value in treating hyperthermia d. They are of limited value in treating hyperthermia

ANS: C Unlike with fever, antipyretics are of no value in hyperthermia because the set point is already normal. Cooling measures are used instead. Malignant hyperthermia is a genetic myopathy that is triggered by anesthetic agents. Antipyretic agents do not have this effect. Antipyretics do not cause seizures and are of no value in hyperthermia.

1. In addition to an increased temperature, which is an early sign of malignant hyperthermia? a. Apnea b. Bradycardia c. Muscle rigidity d. Decreased blood pressure

ANS: C Early signs of malignant hyperthermia include tachycardia, increasing blood pressure, tachypnea, mottled skin, and muscle rigidity. Apnea is not a sign of malignant hyperthermia. Tachycardia, not bradycardia, is an early sign of malignant hyperthermia. Increased blood pressure, not decreased blood pressure, is characteristic of malignant hyperthermia.

Which action is recommended when preparing to do a heel stick on a neonate? a. Apply cool, moist compresses. b. Apply a tourniquet to the ankle. c. Elevate the foot for 5 minutes. d. Warm the heel for 3 minutes

ANS: D Before the blood sample is taken, the heel is heated with warm moist compresses for 5 to 10 minutes to dilate the blood vessels in the area. Cooling causes vasoconstriction, making blood collection more difficult. A tourniquet is used to constrict superficial veins. It will have an insignificant effect on capillaries. Elevating the foot will decrease the blood in the foot available for collection.

It is important to make certain that sensory connectors and oximeters are compatible. Which can incompatible wiring cause? a. Hyperthermia b. Electrocution c. Pressure necrosis d. Burns under sensors

ANS: D It is important to make certain that sensor connectors and oximeters are compatible. Wiring that is incompatible can generate considerable heat at the tip of the sensor, causing second- and third-degree burns under the sensor. Incompatibility would cause a local irritation or burn. A low voltage is used, which should not present risk of electrocution. Pressure necrosis can occur from the sensor being attached too tightly, but this is not a problem of incompatibility.

Which is an appropriate intervention to encourage food and fluid intake in a hospitalized child? a. Force the child to eat and drink to combat caloric losses. b. Discourage participation in non-eating activities until caloric intake is sufficient. c. Administer large quantities of flavored fluids at frequent intervals and during meals. d. Give high-quality foods and snacks whenever the child expresses hunger.

ANS: D Small, frequent meals and nutritious snacks should be provided for the child. Favorite foods such as peanut butter and jelly sandwiches, fruit yogurt, cheese, pizza, and macaroni and cheese should be available. Forcing a child to eat only meets with rebellion and reinforces the behavior as a control mechanism. Large quantities of fluid may decrease the child's hunger and further inhibit food intake.

Which would the nurse do when caring for a child with an intravenous infusion? a. Use a macrodropper to facilitate reaching the prescribed flow rate. b. Avoid restraining the child to prevent undue emotional stress. c. Change the insertion site every 24 hours. d. Observe the insertion site frequently for signs of infiltration.

ANS: D The nursing responsibility for IV therapy is to calculate the amount to be infused in a given length of time; set the infusion rate; and monitor the apparatus frequently (at least every 1 to 2 hours) to make certain that the desired rate is maintained, the integrity of the system remains intact, the site remains intact (free of redness, edema, infiltration, or irritation), and the infusion does not stop. A minidropper (60 drops/ml) is the recommended IV tubing in pediatrics. The IV site should be protected. This may require soft restraints on the child. Insertion sites do not need to be changed every 24 hours unless a problem is found with the site. This exposes the child to significant trauma.

The nurse is preparing to insert a nasogastric tube into a 4-year-old child for intermittent suctioning after abdominal surgery. Place in correct sequence the steps for inserting a nasogastric tube. Provide the answer using lowercase letters separated by commas (e.g., a, b, c, d, e, f). a. Lubricate the nasogastric tube with water-soluble lubricant. b. Tape the nasogastric tube securely to the child's face. c. Check the placement of the tube by aspirating stomach contents. d. Place the child in the supine position with head slightly hyperflexed. e. Insert the nasogastric tube through the nares. f. Measure the tube from the tip of the nose to the ear lobe to midpoint between the xiphoid process and the umbilicus.

ANS: D, F, A, E, C, B The procedure begins by positioning the child in the best position for insertion. Proper placement of the tube is essential, and incorrectly placed tubes can result in significant harm to the patient. Correct determination of the length of the tube is a crucial step in the placement procedure. A convenient and reliable morphologic measurement, the nose-ear-midway to umbilicus (NEMU) span, approached the accuracy of the age-specific prediction equations and is easy to use in a clinical setting. Lubrication will assist the ease of tube insertion. Research supports radiographs as the gold standard for confirmation of enteral tube placement. Additional methods to check placement, all of which can be done at the bedside, include visual confirmation of aspirate and pH testing of aspirate. Although auscultation is still widely used, multiple sources have documented that it is not an accurate method to confirm enteral tube placement. Securing the tube is an important step to keep the tube in place.