Chapter 35 and 36 prep u nclex questions
A nurse is caring for a boy preparing to undergo a dressing change. Which statement by the father lets the nurse know that the child's pain experience is at risk of being intensified? "You can hold my hand if you want to." "Let's think about something you really like." "I will be here for you the whole time." "I hope that you will be a brave boy and not cry."
"I hope that you will be a brave boy and not cry."
The nurse is caring for a client who is in a sickle cell crisis. The child is hospitalized for pain management during the crisis. The parents tell the nurse that they do not think their child needs any pain medication because the child is sleeping a lot. How should the nurse respond? "We need to wait for your child to express the pain level to us before providing medication." "I understand why you think your child is not in pain; sleep is often a way for children to cope with pain." "I agree. Since your child is sleeping the pain must not be too severe. I will hold his pain medication." "The pain medication is prescribed on a routine basis to keep the pain under control, so I have to give it as prescribed."
"I understand why you think your child is not in pain; sleep is often a way for children to cope with pain."
A nurse is requesting that the unlicensed assistive personnel (UAP) take vital signs on a group of children in the pediatric clinic. Which child does not need blood pressure assessed? 6-year-old with asthma 10-year-old with gastroenteritis 14-year-old for athletic physical 2-year-old for well-child check
2-year-old for well-child check
A child with HIV, weighing 25 kg (55.1 lbs), is about to receive an infusion of IVIG. The recommended dose is 400 mg/kg/dose. The medication is available in a concentration of 50 mg/mL. What is the proper amount of infusion that the child will receive? 1000 mL 100 mL 2000 mL 200 mL
200ml
GOOD LUCK ON THE QUIZ WE GOT THIS!!
<3 <3 <3
What scenario demonstrates the nurse's knowledge when using guided imagery to relieve pain in pediatric clients? After achieving a relaxed state, begin by guiding the 3-year-old client to image of a fun birthday party. After achieving a relaxed state, begin by guiding the 13-year-old client to image of walking down a sandy beach and collecting seashells, a favorite activity. Leading a 4-year-old client to image of being an airplane pilot and flying across the sky. Leading a 6-year-old client in a fairy princess setting where the client is the princess and the nurse is the queen.
After achieving a relaxed state, begin by guiding the 13-year-old client to image of walking down a sandy beach and collecting seashells, a favorite activity.
The nurse is caring for children on a postoperative unit. Which nursing action promotes the most efficient pain control? Avoid opioids as these may cause dependency and respiratory depression. Anticipate when pain will occur and plan interventions to prevent it. Assess the child's pain on a scale of 0 to 10, with 10 being the worst. Instruct parents to notify the nurse if the child's pain worsens.
Anticipate when pain will occur and plan interventions to prevent it.
The nurse is flushing a saline lock when the child cries out that it hurts. What is the nurse's next action? Insert a saline lock in a new site. Call the healthcare provider. Assess for signs of infiltration. Continue to flush with saline.
Assess for signs of infiltration.
Moderate sedation is a pain-management technique that is used with children. During moderate sedation for a preschooler, which action would be most important? Keeping the child's head in a dependent position Asking the child to periodically count from 1 to 10 Keeping the room absolutely quiet so the child can sleep Assessing vital signs frequently, because they can become depressed
Assessing vital signs frequently, because they can become depressed
A 4-year-old child is scheduled for a magnetic resonance imaging of the skull following a bicycle accident. Which medication would the nurse administer to keep the child still during this procedure? IV hydromorphone diphenhydramine conscious sedation IV morphine
Concious sedation
A 4-year-old child is scheduled for an MRI. The child's parent is informed that the child will be free of pain but sedated to ensure stillness during the procedure. Which type of anesthesia does the nurse expect this child to have? Patient-controlled analgesia (PCA) General anesthesia Conscious sedation IM injection
Concious sedation
The nurse is administering 2 puffs of an albuterol sulfate inhaler to a 4-year-old. Which side effect would the nurse instruct the parent to most likely expect? Increased heart rate and restlessness Drowsiness causing a nap Increased nonproductive cough Increased mucus expectoration
Increased heart rate and restlessness
The nurse is caring for a pediatric client following an open appendectomy. The client rates the pain an "8" on a 0 to 10 pain scale and the nurse administers morphine sulfate intravenously to the client per the primary health care provider's prescription. Which nursing action is priorityfollowing administration of the medication? Document the client's pain description. Reassess the client's pain level. Monitor the client's respiratory status. Play a game with the client.
Monitor the client's respiratory status.
The pediatric nurse is mentoring a new graduate in the care of children experiencing pain. The nurse knows the teaching was effective when the new graduate makes which statement as the rationale for considering pain assessment the fifth vital sign? Pain assessment is difficult to measure. Nurses often forget to assess pain. Pain assessment needs to be done at regular intervals. It is important to keep children free of pain.
Pain assessment needs to be done at regular intervals.
The nurse is planning immediate postoperative care for an infant after repair of a cleft lip. What should the plan include? Crying is good for the infant to decrease risk of pneumonia after anesthetic. Pain medication should be given on a routine basis. Allow the infant to be as active as possible after surgery. Encourage use of pacifier after surgery.
Pain medication should be given on a routine basis.
The nurse is preparing a 6-year-old for a venipuncture. The boy appears anxious and is crying. How can the nurse foster feelings of control to help minimize his anxiety about the procedure? "What questions do you have about what I am doing?" "Pick your favorite Band-Aid and show me which arm to use." "See how fast you can make this pinwheel whirl." "Mrs. Jones, why don't you have him sit on your lap?"
Pick your favorite Band-Aid and show me which arm to use."
The nurse is assessing an adolescent to rule out appendicitis. The nurse is aware the appendix is located in the right lower quadrant. The teenager is reporting pain in the left lower quadrant. What type of pain should the nurse document? Referred pain Cutaneous pain Chronic pain Localized pain
Referred pain
What behavioral responses to pain would a nurse observe from an infant younger than age 1? Reflex withdrawal to stimulus and facial grimacing Passive resistance, clenching fists, and holding body rigid Low frustration level and striking out physically Localized withdrawal and resistance of the entire body
Reflex withdrawal to stimulus and facial grimacing
The nurse is caring for a comatose school-age child receiving gastrostomy tube feedings. The nurse aspirates 15 ml of stomach contents prior to administering a feeding. What is the appropriate action by the nurse? Discard the stomach contents and continue with the feedings as prescribed. Replace the stomach contents and hold the feeding. Replace the stomach contents and continue with the feedings as prescribed. Discard the stomach contents and notify the health care provider of the aspiration amount.
Replace the stomach contents and continue with the feedings as prescribed.
What is the best method for the nurse to reduce the pain of an IM injection for a child? Administer the injection while the child is asleep. Request an anesthetic cream to apply before injection. Remind the child that this will not hurt. Tell the child that it is best not to cry.
Request an anesthetic cream to apply before injection.
The nurse is preparing a female toddler for the repair of an eyebrow laceration. The girl is most likely to demonstrate which response in anticipation of the procedure? Scream and cling tightly to her parent Remain outwardly calm and ask numerous questions. Attempt to postpone the procedure by asking to "go potty." Stare out the window while clenching her hands.
Scream and cling tightly to her parent
A nurse is caring for a 4-year-old child who is exhibiting extreme anxiety and behavior upset prior to receiving stitches for a deep chin laceration. Which nursing intervention is priority? Conducting a baseline physical assessment Serving as an advocate for the family to ensure appropriate pharmacologic agents are chosen Ensuring that emergency equipment is readily available Ensuring the lighting is adequate for the procedure but not so bright to cause discomfort
Serving as an advocate for the family to ensure appropriate pharmacologic agents are chosen
The nurse is caring for a 12-year-old postoperative spinal rod placement client with scoliosis. Which factor might intensify the child's postoperative pain experience? Pain control methods were discussed with the client prior to the procedure. The parents describe the client as being a difficult child. The client is 12 years old. The client had a painful experience with an appendectomy at age 10.
The client had a painful experience with an appendectomy at age 10.
If a medication is being administered by the otic route, it will be administered in which way? Rolled between the hands and drawn up into a small syringe Lubricated and gently placed into the rectum Warmed to room temperature and dropped into the eye Warmed to room temperature and dropped into the ear
Warmed to room temperature and dropped into the ear
Immediately following administering a medication by enteral tube, the nurse will: flush the tube with water. position the child on his left side. check for signs of nausea or vomiting. elevate the head of the bed.
flush the tube with water.
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: is going to give an IM injection in the vastus lateralis. explained why the medication was being administered. used the child's weight to calculate the dosage. had two whole tablets to administer to the child.
had two whole tablets to administer to the child.
The charge nurse is assisting the new graduate nurse in administering eye drops to a child. The charge nurse would stop the new graduate if which action was observed? 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 administers drops into conjunctival sac
holds the eyelids apart for about 30 seconds
The nurse is caring for a 6-year-old sickle-cell client in an acute care setting. A high priority for this client's plan of care is pain relief. The nurse understands that untreated acute pain can lead to which physiologic effects? impaired mobility, anorexia, anxiety, sleep disturbances, and developmental regression sleep disturbances, nocturnal enuresis, and impaired mobility constipation, nausea, and vomiting nausea, vomiting, migraine headaches, and developmental regression
impaired mobility, anorexia, anxiety, sleep disturbances, and developmental regression
The nurse is caring for a client receiving opioid medication for the treatment of postoperative pain. What are common side effects that the nurse should observe for? respiratory depression, constipation, and pruritis constipation, hypertension, and disorientation respiratory depression, diarrhea, and hypotension hypotension, nausea and vomiting, and diarrhea
respiratory depression, constipation, and pruritis
What are some negative effects that chronic pain can have on the pediatric population? weight loss, increased blood pressure, and increased heart rate increased blood pressure, increased heart rate, and sleep disturbances sleep disturbances, exhaustion, irritability, mood disturbances, and depression increased appetite, sleep disturbances, and irritability
sleep disturbances, exhaustion, irritability, mood disturbances, and depression
The nurse is caring for a 12-year-old post-appendectomy client who weighs 86 pounds. The child has a temperature of 38.5ºC (101.3ºF). The nurse prepares to give the client a dose of oral acetaminophen. The order reads "Tylenol 15mg/kg/dose every 4 to 6 hours PO PRN for fever or pain." How many milligrams of Tylenol should the nurse give the client? 1.3 milligrams 1,290 milligrams 147 milligrams 587 milligrams
587 milligrams
The nurse is preparing to administer medication to a 10-year-old who weighs 70 lb (32 kg). The prescribed single dose is 3 to 4 mg/kg per day. Which dose range is appropriate for this child? 96 to 128 mg 420 to 560 mg 105 to 140 mg 210 to 280 mg
96 to 128 mg
A child is prescribed several diagnostic procedures. How can the nurse advocate for this client? Advocate for procedures to be separated to allow time for food and rest. Ask that the procedures be scheduled back to back to prevent fatigue. Attend all procedures with the child when going to another area of the hospital. Ensure that all procedures are performed with the child under general anesthesia.
Advocate for procedures to be separated to allow time for food and rest.
The nurse is caring for a child with an ileostomy. What nursing intervention will be included in this child's plan of care? Clean the outside of the collection device. Leave the ileostomy open to the air. Check for leakage around the stoma. Apply a sterile dressing around the stoma.
Check for leakage around the stoma.
A 6-year-old client is prescribed to receive an oral antibiotic. What should the nurse do before giving the child this medication? Give the child a small glass of water to drink. Give the child the medicine before the next meal. Tell the child that the medicine can be given as an injection instead. Check to see if the child can swallow pills.
Check to see if the child can swallow pills.
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? Contact the health care provider. Request a chest X-ray for evaluation. Discontinue the IV infusion. Assess intake, output, and weight.
Discontinue the IV infusion.
A nurse is preparing a dose of insulin to give the client. Which action takes priority when preparing and administering this medication? Ask the client if he or she has had any adverse reactions to insulin in the past. Double-check the dose with another RN before giving. Have another RN witness the injection given to the client. Double-check the math calculations.
Double-check the dose with another RN before giving.
The nurse is caring for an infant who was injured in a severe automobile accident. The child experienced several fractures and is in significant pain. The child's mother questions if this will impact her child later in life. What information should be provided by the nurse? Although the pain is severe at this time a child under the age of 2 will not be able to recall the event. Experiences with pain even in infancy can influence an individual's response to pain later. There are no studies that consider the impact of pain in infancy on the child later in life. Pain that is short in duration in infancy will not influence the child later.
Experiences with pain even in infancy can influence an individual's response to pain later.
When educating a parent on how to support the child while experiencing a painful procedure, what is the best information for the nurse to convey? Explain in detail the role of the parent as a coach and emphasize the coping plan. Encourage the parent to stay with the child no matter how the child reacts. Encourage the parent to focus on the procedure itself. Have the parent to continuously apologize to the child during the procedure.
Explain in detail the role of the parent as a coach and emphasize the coping plan.
The nurse is preparing a 6-year-old child for a bone marrow biopsy. The child is very anxious about going through this procedure. Which nursing diagnosis best fits this situation? Fear related to anticipation of painful procedure Pain related to fear and anxiety of painful procedure Disturbed sleep pattern related to fear of pain Pain related to an invasive procedure
Fear related to anticipation of painful procedure
A 5-year-old child has been admitted to the hospital and is going to have an IV started in the procedure room. Which instructions will be most helpful for the child and the parent? Instruct the parent to help restrain the child during the procedure. Instruct the parent to stay in the back of the procedure room. Have the parent wait in the hospital room until the procedure is over. Have the parent sing softly to the child during the procedure.
Have the parent sing softly to the child during the procedure.
The nurse has prepared an IM injection to give a 13-year-old child. After some searching, the nurse locates the child in the playroom in front of a video game. Which action is best for the nurse to take? Give the injection in the playroom since the child is distracted with the video game. Ask the child when the game will be over. Ask the child to take a break from the game and come back to the child's room to give the injection. Inform the child that it is time for an injection. Explain why the injection is needed and have the child move to the treatment room.
Inform the child that it is time for an injection. Explain why the injection is needed and have the child move to the treatment room.
The nurse is administering an oral liquid medication to a 5-year-old child. What would be the most appropriate for the nurse to do when administering this medication? Sorry the website refreshed
Let the child hold the medication cup.
The nurse is preparing to give a 4-month-old an oral medication. Which technique demonstrates the nurse's accurate knowledge of the infant's developmental level? Position the infant supine in bed, and squirt the medication on the tongue toward the cheek. Place the medication in a bottle with a small amount of juice, then feed the infant the bottle in an upright position. Place the medication in a bottle with a small amount of the infant's formula and feed the bottle to the infant in an upright position. Position the infant upright, offer the infant a bottle of formula, remove the bottle and squirt the medication on the side of the tongue toward the cheek, then offer the infant the bottle again.
Position the infant upright, offer the infant a bottle of formula, remove the bottle and squirt the medication on the side of the tongue toward the cheek, then offer the infant the bottle again.
A nurse is administering ear drops to a 7-year-old girl. What should the nurse do? Pull the pinna of the ear up and back to straighten the external ear canal. Hold the child's head in the sideways position while counting to 5 to ensure the medication fills the entire ear canal. Warn the child that the drops will hurt. Administer the medication while it is still cold from the refrigerator.
Pull the pinna of the ear up and back to straighten the external ear canal.
The nurse is preparing to give a diphtheria, pertussis, and tetanus (DPT) immunization to a child in an acute care setting before discharge. The label on the DPT bottle indicates the immunization expired yesterday. What is the correct nursing action to take? Return the bottle to the pharmacy and request a replacement. Inform the prescribing practitioner. Give the injection since it is only one day expired. Discard the bottle.
Return the bottle to the pharmacy and request a replacement.
Which statement is the goal of distraction techniques used to control pain? to relieve pain through the use of specific techniques eliminating the need for pain medication to include the child in purposeful behaviors to reduce the amount of pain medications to divert the child's attention away from the pain through controlled, purposeful behaviors to reduce parental anxiety by entertaining the child
to divert the child's attention away from the pain through controlled, purposeful behaviors
The nurse is caring for a 2-year-old postoperative PET client. Which consideration is the most appropriate for this child's developmental stage? understands time uses delays to put off treatment uses words for pain such as owie, boo-boo, or hurt fears bodily mutation or injury
uses words for pain such as owie, boo-boo, or hurt
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 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."
"The client is left-handed and likes to draw; an IV site in his right arm would be best."
The nurse is caring for a 5-year-old child who underwent a painful surgical procedure earlier in the day. The nurse notes the child has not reported pain to any of the nursing staff. Which action by the nurse is indicated? Encourage the child to report pain Contact the physician to report the child's condition Administer prophylactic analgesics Observe for behavioral cues consistent with pain
Encourage the child to report pain
The nurse is preparing to assess the pain of a developmentally and cognitively delayed 8-year-old. Which pain rating scales should the nurse choose? Visual Analog and Numerical Scales Adolescent Pediatric Pain Tool Word Graphic Rating Scale FACES pain rating scale
FACES pain rating scale
The nurse is educating the parents how to administer daily oral medication to their 5-year-old boy. Which response indicates a need for further teaching? He needs to take his medicine or he will lose a privilege." "I should never refer to the medicine as candy." "We should never bribe our child to take the medicine." "We checked that the medicine can be mixed with yogurt or applesauce."
He needs to take his medicine or he will lose a privilege."
Which type of medication lacks a ceiling effect, and therefore is prescribed in initial doses that must be titrated to achieve pain relief while managing side effects? ibuprofen aspirin morphine acetaminophen
Morphine
Parents asks the nurse why their premature infant is receiving a feeding through the mouth rather than the nose. What is the best explanation by the nurse? Nasogastric tubes decrease the possibility of striking the vagal nerve. Newborns are obligate nose breathers so nasogastric may obstruct their breathing. It is equally acceptable to use either insertion site. Orogastric tube insertion can cause inflammation and obstruction of the nares.
Newborns are obligate nose breathers so nasogastric may obstruct their breathing.
In caring for the child with asthma, the nurse recognizes that bronchodilator medications are administered to children with asthma for which reason? Relief of acute symptoms Prevention of mild symptoms To stabilize the cell membranes Management of chronic pain
Relief of acute symptoms
A client's parent informs the nurse about having a hard time getting the 6-year-old child to take the liquid medication at home. Which would be the best suggestion for the nurse to offer this parent to help correct this concern? Tell the parent to state firmly, "It's time for you to drink your medicine." Tell the parent to tell the child, "It tastes just like candy!" Tell the parent to ask nicely, "Will you drink this for me?" 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."
The nurse is providing family education for the administration of ibuprofen. Which response indicates a need for further teaching? "This can be taken with other medications we have at home that didn't require a prescription." "I should monitor for signs of easy bruising or bleeding gums. "This medication is taken by mouth." "This should be given with food to avoid upsetting his stomach."
ask if the child would like to take the medicine in a cup or through an oral syringe
The nurse is caring for a 7-year-old with a low-profile gastrostomy tube placed 6 months ago. Which is the priority intervention to prevent irritation of the skin at the insertion site? cleansing the skin around the site with an alcohol wipe after each feeding cleaning the surrounding skin with soap and water daily plus keeping the area dry rotating the gastrostomy tube or button daily cleaning under the external disc or bumper with diluted hydrogen peroxide
cleaning the surrounding skin with soap and water daily plus keeping the area dry
The nurse knows that which situation will prevent an adolescent from having an MRI (magnetic resonance imaging)? hair pins and eye makeup watch and jewelry pierced ears and tongue metal dental braces
metal dental braces
The nurse is caring for a child receiving an epidural opioid medication. The nurse will ensure which medication is readily available for this client? ibuprofen naloxone alprazolam cetirizine
naloxone
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: call the child's name and see if he or she answers. read the child's armband. tell the child to state his or her nickname. ask the child to state his or her name.
read the child's armband.
The nurse is working with a 5-year-old boy who must receive repeated intravenous injections as part of his treatment. He hates the injections, however, and is frightened whenever he sees the syringe and needle. In an attempt to overcome this fear, the nurse holds the syringe up for him to see and tells him, "This looks kind of like a space rocket, don't you think? Here comes the space rocket—it needs to refuel." Which pain management technique is the nurse using here? Imagery Hypnosis Thought stopping Biofeedback
Imagery
The primary health care provider prescribed ketoconazole for a child with ringworm. Which statement by the parents indicates the nurse needs to provide additional teaching on the prescription? "If this medication gets in my child's eyes, I will rinse with water immediately." "My child needs to take the full prescribed dosage." "I will wrap the skin tightly after applying the medication." "I will wash my hands before and after I apply this medication."
"I will wrap the skin tightly after applying the medication."
Which statement by the parent lets the nurse know that teaching about antibiotics prescribed 3 times a day for the child with strep throat has been effective? "My child can skip the dose during the day while at school." "I will decide which times work best, based on our family's schedule." "I will give this medication until my child feels better." "It is important to give my child the full course of antibiotics."
"It is important to give my child the full course of antibiotics."
A parent asks the nurse to explain what a PET scan is after learning that the child will be having a PET scan of the abdomen. What is the nurse's best response? "It would be best to ask your provider about this procedure." "It is similar to a CT scan but uses an injection of dye to help visualize the abdominal organs." "It is a very short procedure done in the diagnostic imaging department." "It stands for positron emission tomography, which is different from computed tomography."
"It is similar to a CT scan but uses an injection of dye to help visualize the abdominal organs."
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." "The feedings are high in sugar and insulin is needed to manage this." "There is no need to worry. This is temporary." "There is a chance these feedings your child is receiving are causing her to have diabetes."
"The feedings are high in sugar and insulin is needed to manage this."
The nurse is caring for a 17-year-old child who was sprained her ankle. The physician has prescribed ibuprofen to manage the pain. What statement by the teen indicates the need for further instruction? "This medication may cause me to bruise easier than I normally do." "I may experience an upset stomach on this medication." "This medication should be taken on an empty stomach." "Taking this medication with food is often helpful to prevent me from feeling sick."
"This medication should be taken on an empty stomach."
The nurse is caring for a 9-year-old boy with episodes of chronic pain. The nurse is educating the parents how to help the child manage pain nonpharmacologically. Which statement indicates a need for further teaching? "We need to identify the ways in which he shows pain." "We should start the method after he feels pain." "We should select a method that he likes the best." "We should perform the techniques along with him."
"We should start the method after he feels pain."
A 4-year-old child is being prepared to undergo a bronchoscopy to remove an aspirated pea. The nurse knows that the parents need additional teaching based on which statement? "We will be able to take our child home immediately after the procedure is completed." "Our child will be sedated during the procedure." "The health care provider will put a tube into my child's throat to remove the obstruction." "We can go with our child to the holding area and stay with him until the procedure starts."
"We will be able to take our child home immediately after the procedure is completed."
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.
1-Place the child in the supine position, slightly hyperextending the neck with the head lower than the body 2-Retract the lower conjunctival sac 3-Place the prescribed number of drops into the lower eyelid 4-Instruct the child to gently close the eyes 5- Wipe any excess medication from the skin
A 7-year-old boy tells the nurse that his head sometimes hurts after he eats ice cream. The nurse recognizes that this type of pain is: Acute referred pain Chronic somatic pain Chronic cutaneous pain Acute visceral pain
Acute referred pain
The nurse is caring for a 12-year-old in sickle cell crisis. The nurse determines that the child is very tense and might benefit from relaxation techniques. Which is the best approach for the nurse to take when implementing this pain reduction technique? Ask parents and visitors to leave the room during this intervention. Close the door to the client's room, dim the lights, and close the curtains before beginning. Allow the television to remain on during this intervention to provide distraction for the client. Begin the intervention by having the child breathe in and out quickly 10 times.
Close the door to the client's room, dim the lights, and close the curtains before beginning.
The nurse is caring for a 7-year-old postoperative child who is reporting an 8 out of 10 on a pain intensity scale. The child's parent is requesting pain medication. The child received ibuprofen 3 hours ago. What is the correct nursing action? Apologize to the parent and tell the parent there is nothing the nurse can do at the moment. Turn on the television in hopes of distracting the child. Explain to the parent the child cannot receive another dose of ibuprofen for 3 hours. Contact the health care provider and request an opioid pain medication.
Contact the health care provider and request an opioid pain medication.
The nurse is preparing a school-age child for a diagnostic procedure. What is an important nursing role in relation to obtaining informed consent for this procedure for this client? Present education and preparation to the parents only. Ensure the child understands and assents to the test. Inform the parents of all benefits and risks. Allow the child to determine the timing of the procedure.
Ensure the child understands and assents to the test.
The nurse is giving discharge instructions to a parent of a 3-month-old infant. What is the bestinformation to give the parent concerning oral medication administration? Lay the infant in a crib and, over time, use a syringe to squirt small amounts of medicine beside the tongue. Mix the oral medication in a small amount of formula or breast milk in a bottle. Hold the infant's nose while squirting the medication into the mouth. Give the medication with a syringe and direct the liquid toward the posterior side of the mouth while holding the infant upright.
Give the medication with a syringe and direct the liquid toward the posterior side of the mouth while holding the infant upright.
The nurse is providing postsurgical care for a 4-year-old boy following hernia repair. Before surgery, the nurse taught the child to use the poker chip tool to rate his pain. When assessing the child's postsurgical pain, the boy refuses to touch the chips and clings to his mother. How should the nurse respond? Select the visual analog scale as the best one to use. Give the mother the FACES pain rating scale to use with her son. Substitute the word-graphic rating scale for the poker chips. Show the child once more how to use the chips.
Give the mother the FACES pain rating scale to use with her son.
Included in the nursing care plan for the child receiving total parenteral nutrition (TPN) will be which intervention? Regularly monitoring the child's blood glucose Keeping the child nothing by mouth (NPO) Flushing the peripheral catheter delivering the TPN solution regularly with saline A daily stool softener
Regularly monitoring the child's blood glucose
An aunt at the bedside of a 7-year-old holds the child's hand and gently traces her fingers up and down the child's arm while talking softly about pleasant experiences on the grandparents' farm. This relative is using what technique to reduce pain? Select all that apply. Biofeedback Relaxation Positive self-talk Nonpharmacologic management Behavioral-cognitive strategy
Relaxation Nonpharmacologic management Behavioral-cognitive strategy
An experienced pediatric nurse is orienting a new graduate nurse. Which action by the new graduate would require intervention by the experienced nurse? The nurse identifies the child using the ID band and asking the child's name. The nurse asks the experienced nurse to check the dosage calculations. The nurse looks up the medication in the Harriet Lane book. The nurse offers the medicine to the child and says to "take this liquid candy."
The nurse offers the medicine to the child and says to "take this liquid candy."
The nurse teaches a preschooler to use a FACES pain rating scale prior to surgery. At that time, the preschooler points to the smiling face. Following surgery when the nurse suspects the child has pain, the preschooler points again to the smiling face. How would the nurse interpret this response? The child has difficulty focusing on the right side of the scale. The child does not have pain. The child is using the scale to predict what he or she would like, not what the child has. The nurse must be interpreting the child's degree of pain falsely.
The child is using the scale to predict what he or she would like, not what the child has.
Which nursing assessment indicates that a child's pain has been relieved following administration of an analgesic? Select all that apply. The child's pulse rate returns to normal. The child's pain on the Baker Wong scale is a 10. The child resumes play activities. The child is wincing, moaning, and holding the abdomen. The child states the pain is now tolerable. The child rates pain less than previously rated.
The child resumes play activities. The child's pulse rate returns to normal. The child states the pain is now tolerable. The child rates pain less than previously rated.
The nurse is caring for a 2-year-old child who has been hospitalized after being injured in an automobile accident. During the assessment the child is quiet and watchful of all the nurse's actions. When considering the level of pain being experienced by the child what inference can be made? The child is most likely tired. The child is not experiencing any significant level of pain or discomfort. The child's nonverbal behaviors may indicate the presence of discomfort. The child is feeling too shy to communicate any pain or discomfort.
The child's nonverbal behaviors may indicate the presence of discomfort.
The nurse has been teaching an adolescent about the treatment for hypothyroidism. Which outcome indicates that the teaching has been successful? The parents recognize that thyroid medication be taken with food. The client states understanding that this is a lifetime medication The parents acknowledge the need for a follow-up appointment in a year. The client verbalizes the requirement to restrict future athletic activities.
The client states understanding that this is a lifetime medication
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 offer to play a game with the child if the child takes the medicine leave the medicine on the night stand so the child can take it independently compare the taste of the medicine to a chocolate bar
The nurse verifies the position of the feeding tube.
When administering medications to an infant, what information would be most important for the nurse to consider? The infant will take oral medications more readily after he or she has been fed. The infant will take a medication more readily if the flavor is disguised. The infant will take medications more readily if he or she is allowed to move the head as desired. The oral medication should be directed toward the posterior side of the mouth when using a syringe or dropper.
The oral medication should be directed toward the posterior side of the mouth when using a syringe or dropper.
The student nurse is preparing to care for a recently placed gastrostomy tube. Which action would prompt further instruction from the overseeing nurse? The student gently dries the area after cleaning it. The student uses nonsterile gloves for the procedure. The student obtains a sterile water to clean the area surrounding the tube. The student obtains an antimicrobial soap to clean the area surrounding the tube.
The student obtains an antimicrobial soap to clean the area surrounding the tube.
A preschool child has been admitted to the hospital. Which prescription should the nurse question? nasogastric tube to suction NPO IV normal saline 25 ml/hour tap water enema 500 ml
tap water enema 500 ml