Peds ch 22:2

The primary health care provider prescribes iron supplements to a patient with anemia. What does the nurse instruct the patient about the prescription?

"You should avoid foods that contain starch." (Iron supplements interact with foods that contain starch, and this decreases the absorption of iron. Therefore, the nurse instructs the patient to avoid starch-containing foods. Iron supplements do not interact with low-carbohydrate foods. A patient taking vitamin C supplements should avoid eating foods rich in vitamin B12, as their interaction decreases the absorption of vitamin B12. Iron supplements do not interact with tyramine-containing foods like yogurt and processed meats. These foods are essential for healthy growth.)

What is the maximum volume of a drug administered via the intramuscular route in an infant?

0.5 mL (The maximum volume for intramuscular administration in infants is 0.5 mL. The maximum volume for intramuscular administration in a toddler is 1.0 mL. Administering 1.5 mL of a drug intramuscularly to school-age children and adolescents via the vastus lateralis muscle is possible. However, the maximum volume administered in school-age children and adolescents via the vastus lateralis muscle is 2.0mL.)

The primary health care provider prescribes 2 mg of a drug to an infant. The nurse reads the medication label, which states 5 mg/2 mL of drug. How many milliliters (mL) of the drug does the nurse administer to the infant? Answer: ____________ mL

0.8 ( The formula, Unit/Dosage on hand × Dosage wanted/Unit to give, is used to calculate the dosage administered to an infant in mL. Therefore, on substituting the values in the formula, 2 mL/5mg ×2 mg/? mL , the amount of the drug to be administered would be 4/5 = 0.8 mL.)

Arrange the order of nursing interventions for assessing the body temperature of a 2-month-old infant after washing hands.

1 Pulling the ear lobe of the infant down and back 2 Aiming the thermometer at the opposite eyebrow 3 Performing hand hygiene 4 Documenting the procedure in the record

The nurse is administering oral medication to an infant. In which order should the nurse perform the interventions during medication administration?

1 Verifying medication orders 2 Placing the legs of the infant's between the knees 3 Placing one of the arms of the infant behind the back 4 Giving the medication slowly by cup or syringe 5 Providing a 'chaser' according to the infant's age and diet prescription 6 Documenting in the medication administration record

The primary health care provider instructs the nurse to administer 250 mg of a medication to an infant weighing 15 lb. What is the dose per kg of the medication prescribed to the infant? Answer: ____________ mg/kg

36.6 mg/kg (The dose ordered by the primary health care provider is 250 mg. The weight of the infant in kg is 15/2.2= 6.82. Therefore, the dose of the medication per kg of the child would be 250/6.82=36.6 mg/kg.)

A child has a foreign body obstruction of the airway. The nurse makes the child stand, wraps her arms around the child's waist, and makes a fist with one hand. The nurse places the thumb of the fist on the child's abdomen. The nurse then grasps the fist with the other hand and presses the abdomen with a quick upward thrust. Which maneuver is the nurse using in the child?

Abdominal thrust

Which factors contribute to variations in blood pressure? Select all that apply.

Age; Gender; Exercise (The factors that contribute to the variations in blood pressure measurements include age, gender, and exercise. Blood pressure is low in children with respect to adults, as children have a comparatively low cardiac output. Blood pressure is lower in females than in males due to the influence of female sex hormones. There is an increased demand for blood supply from the musculoskeletal system while performing exercise or any other physical activity. This increases cardiac output, which causes high blood pressure. Culture does not affect the variations caused in blood pressure measurements. The weight of a person does not necessarily cause variations in blood pressure; however, being overweight may increase the risk of high blood pressure in susceptible individuals. )

While collecting a urine sample from an infant, the trainee nurse cleans and dries the infant's perianal skin using baby powder, and then applies the adhesive urine collector between the anus and the perineum, drains the urine bag collector into the specimen bottle, and places it into a plastic bag. Which action of the trainee nurse needs correction?

Cleaning and drying using baby powder (Using baby powder to clean the infant's perineum may leave a residue in the perineal area. The residue may interfere with the adhesiveness of the urine collector. The adhesive urine collector can be applied to the tiny area of skin between the anus and the perineum. After the urine is collected, the nurse should drain the urine bag collector into a clean beaker or specimen bottle by removing the tab in its lower corner. Finally, the nurse should place the collector with the specimen into a plastic bag.)

While preparing a patient for a magnetic resonance imaging (MRI) scan, the nurse finds that the patient has tattoos. Which complication does the nurse expect in the patient while performing the MRI scan? Select all that apply.

Edema; Burning ( MRI radiations react with the chemicals present in tattoos and other permanent cosmetics. The radiation can also cause skin irritation. This skin irritation is characterized by edema and burning. Fatigue is not a complication associated with MRI scanning. Fatigue is associated with lifestyle factors, medical conditions, or psychological problems. Phlebitis is not a complication associated with MRI scanning. Phlebitis is a complication associated with intravenous infusion. )

How often should the nurse assess the IV line of a pediatric patient?

Every hour (Intravenous (IV) medications can cause phlebitis, and the nurse must observe the child's IV site hourly for reddened areas or signs of inflammation. Infiltration is a risk for children who are active, and the site should be observed hourly because infants cannot communicate the burning or pain that may accompany infiltration. The nurse should monitor the rate of the IV flow, refill the burettes hourly, observe the condition of the IV site, identify the responses of the child, and document findings.)

What are the complications associated with bradycardia in infants? Select all that apply.

Fatigue; Heart failure (Bradycardia is a medical emergency in infants and should be treated immediately. Decrease in heart rate decreases the cardiac output. Stroke volume is less in infants, so maintenance of cardiac output is solely dependent on the infant's heart rate. A decrease in the blood supply to the brain and the musculoskeletal system due to low cardiac output may result in fatigue. Decreased cardiac output may also compromise the blood supply to all major organs of the body, which leads to heart failure. Hypothermia in children may be caused by exposure to cold. Infants are susceptible to dehydration and hypothermia due to their large body surface area. Hyperthermia occurs in the infant due to drug reactions, trauma, or increased environmental temperature.)

Which drugs may interact with phenytoin (Dilantin) and decrease its therapeutic effect? Select all that apply.

Folic acid (Folicet); Erythromycin (Erythrocin); Theophylline (Lanophyllin) ( Folic acid (Folicet) and erythromycin (Erythrocin) are the drugs that interact with phenytoin (Dilantin) and decrease the therapeutic effect of phenytoin (Dilantin). Additionally, theophylline (Lanophyllin) interacts with phenytoin (Dilantin) and results in the decreased therapeutic effects of both drugs. Isoniazid (Laniazid) and valproate (Depakene) interact with phenytoin (Dilantin) and cause phenytoin toxicity, but they do not decrease the therapeutic effect. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation. )

The nurse is monitoring a child with an esophageal defect who underwent a gastrostomy tube insertion. Which finding after the procedure would cause the nurse to immediately notify the primary health care provider?

Green or brown drainage (The presence of brown or green drainage indicates that the tube has slipped through the pylorus into the duodenum. As this procedure can cause intestinal obstruction, the primary health care provider must be notified. The nurse should observe the signs of vomiting and abdominal distension in the child after the procedure. However, these complications are not life threatening and do not need immediate intervention. Irritation at the site of tube insertion may occur due to formula or gastric secretions. Cleansing the skin around the tube would prevent irritation. The primary health care provider does not need to be immediately notified of this complication.)

Which nursing actions are performed while administering an injection to the infant? Select all that apply.

Holding the infant in the 'hug' position; Removing the needle rapidly after injection; Rubbing the site of administration with an ice cube before injection (Holding the infant in the 'hug' position helps in comforting the infant and prevents the building up of muscle tension while giving the injection. This increases the ease of administrating the injection. The needle is inserted and removed rapidly to help increase the absorption of the drug and promote comfort. The injection site should be rubbed with an ice cube or alcohol-dipped wipes to numb the site before injection. The extremities should not be restrained after injection, as this may prevent the absorption of the drug. Restraining the infant on the bed before the injection may induce unnecessary fear and should be avoided.)

Which is the best nursing action while administering an enema to an infant?

Holding the infant's buttocks together (The nurse should hold the infant in an appropriate position while administering an enema in order to obtain the desired effect of the enema. Infants are unable to retain the enema solution; therefore, the nurse should hold the infant's buttocks together for a short period of time. The infant is held in the football position when one hand needs to be free. However, this position is not helpful while administering an enema, as the infant is not well supported in this position. Accessing the anus to administer an enema is difficult in the cradle position. Therefore, holding the infant in the cradle position is not appropriate while administering an enema. The colic carry position is helpful when the infant is irritable and this position is helpful to prevent regurgitation; however, it is not helpful while administering an enema to the infant.)

A patient on bleomycin (Blenoxane) therapy is prescribed supplemental oxygen. Which outcome would the nurse expect in the patient?

Increased lung toxicity (Oxygen interacts with bleomycin (Blenoxane) and causes increased lung toxicity. Increased hepatic toxicity occurs because of drug-drug interaction between isoniazid and valproate. The interaction between oxygen and bleomycin (Blenoxane) does not decrease oxygen absorption. The drug-drug interaction between oxygen and bleomycin (Blenoxane) does not affect the absorption of bleomycin (Blenoxane).)

Which complication does the nurse anticipate in the child due to the concomitant administration of theophylline (Lanophyllin) and antacids?

Increased toxicity of the antacids ( The drug-drug interactions between antacids and theophylline (Lanophyllin) leads to increased absorption of antacids, which may lead to antacid toxicity in the child. The absorption of antacids decreases when they interact with steroids, antibiotics like tetracycline, and digoxin (Lanoxin). Only the therapeutic activity of antacids is affected due to the concomitant administration of theophylline (Lanophyllin) and antacids. The absorption of theophylline (Lanophyllin) is not affected due to interaction with antacids. )

While caring for a 5-year-old child, the nurse observes that the child's body temperature is 40° C (104° F). The nurse also observes that the child has reduced skin turgor and dried mucous membranes. Which are the suitable nursing interventions for the child? Select all that apply.

Increasing the child's fluid intake Avoiding the use of alcohol sponge baths Administering tepid sponge baths to the child ( The body temperature of the child is 40° C (104° F), which indicates that the child has a high fever. Signs such as reduced skin turgor and dried mucous membranes indicate dehydration. The child's metabolic rate increases during fever, and, therefore, more water is lost from the body, which leads to dehydration. As such, the nurse should increase fluid intake by giving fruit juices and water. Alcohol sponge baths should be avoided during fever, as they cause skin irritation. Tepid sponge baths can be given to the child, as they help reduce fever and induce relaxation. Cold water should not be used, as it may cause shivering. The child's skin should be exposed to the air after the sponge bath to promote evaporation and cooling of the skin. Exposing the skin to the air also prevents shivering. )

The nurse is caring for a 1-year-old child in a health care facility setting. Which measures would the nurse take to ensure the safety of the child? Select all that apply.

Keeping baby wipes and safety pins out of reach of the child; Keeping baby wipes and safety pins out of reach of the child ( The nurse should be well aware of the safety measures in the children's unit of the health care facility. The nurse should keep baby wipes and safety pins out of reach from the child, as they may cause infection or injury. The nurse should inspect toys for sharp edges and removable parts, as a 1-year-old child has a tendency to put everything in the mouth, which may ultimately result in injury or choking. The nurse should not prop the feeding bottles, as it may result in choking. It is inappropriate to allow the child to play in a wheelchair, supervised or not. Leaving any medication along the bedside should be avoided, as the child may accidently ingest them. Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be very helpful, because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur.)

A child on the pediatric unit has an order for a 24-hour urine specimen. Six hours after initiating the specimen collection, the parents inform the nursing staff that the child was incontinent. What instruction does the nurse provide to the parents at this time?

Lost specimens necessitate restarting the test. (At times a 24-hour urine specimen may be requested to determine the rate of urine production and measure the excretion of specific chemicals from the body. The nurses on each shift must closely supervise this test to maintain its accuracy because lost specimens necessitate restarting the test.)

The primary health care provider instructs the nurse to instill eardrops in a 4-year-old child who has ear pain. Which nursing actions would ensure safe and effective drug administration? Select all that apply.

Massaging the area in front of the ear gently after instilling eardrops; Pulling the upper pinna of the affected ear upwards and backwards; Placing the child in supine position after administering the ear drops ( After administering the medication into the ear canal, the nurse should gently massage the area in front of the ear to facilitate absorption of the drug. The nurse should pull the upper pinna of the child's ear in an upwards and backwards direction to straighten the auditory canal. This facilitates easy entry of the drops. The nurse should place the infant in the supine position or side lying position with the unaffected ear facing down before administering the medication. This helps provide better access to the affected ear for drug administration. The nurse should pull the earlobe downwards and backwards in children under 3 years of age to straighten the canal and to facilitate easy entry of the drops. The child should not be placed in Fowler's position after administration, as it may prevent proper absorption of the drug. )

The nurse is caring for an infant who has undergone tracheostomy. Which specific nursing interventions would be beneficial to the infant while feeding? Select all that apply.

Placing the infant in Fowler's position Covering the tracheostomy with a moist piece of gauze ( The nurse should position the infant in Fowler's position while feeding to prevent the regurgitation of food. While feeding the infant, the nurse should cover the tracheostomy tube with a bib or a moist piece of gauze to prevent aspiration of food particles into the tube. Elevating the infant's head is not an appropriate intervention while feeding and may cause discomfort. Oxygen should be administered using a manual resuscitator before and after tracheostomy to prevent hypoxia, but not after feeding. The tapes should be loose enough to allow one finger to be easily inserted between the tapes and the neck. However, this is not a specific intervention before feeding the infant. )

Which arteries would the nurse palpate to assess the pulse rate of an obese infant? Select all that apply.

Radial; Temporal; Mandibular ( The nurse palpates the pulse in the large arteries, which lie close to the skin. Palpation takes place in the radial artery pulse in the radial site of the distal forearm. Detection of the temporal pulse in front of the ear in the infant is a common practice. Mandibular pulse is also detected easily in the lower jawbone in infants. Carotid artery pulsations are not a preferred site of assessing pulse, as they are not very clearly detected in obese children. The dorsal pedal artery is not a preferred site for determining pulse, as it is not well developed in infants. )

After recording the temperature of a child, the nurse documents the temperature as 'Temperature- 37.7° C (normal).' Which site did the nurse use to measure the temperature?

Rectal (The normal range of rectal temperature is 37.0 to 37.7°C. As the documented temperature falls within the normal limits, the nurse would have assessed the rectal temperature of the child. The normal range of oral temperature is 36.4 to 37.4°C. As the documented temperature exceeds the range, the nurse would not have assessed the oral temperature. The normal range of axillary temperature is 35.8 to 36.6°C. As the documented temperature does not fall within these limits, the nurse would not have assessed the axillary temperature. The normal range of tympanic temperature is 36.9 to 37.5°C. As the documented temperature exceeds the range, the nurse would not have assessed the tympanic temperature.)

While monitoring a child who is on intravenous (IV) therapy, the nurse finds that the child has developed phlebitis. Which finding led the nurse to this conclusion?

Reddened areas around the IV infusion site (Reddening of the skin and other signs of inflammation around the IV infusion site indicate that the child has developed phlebitis. Increased pulse rate and increased blood pressure indicate fluid overload due to the rapid flow rate of the IV solution. Blanched skin at the IV site indicates that the child has developed infiltration.)

While caring for a 3-month-old infant who is on a gastrostomy tube feeding, the nurse finds that there is 25 mL of residue in the infant's stomach. What will be the first nursing intervention to ensure safe administration of the infant formula?

Removing the residual contents from the infant's stomach (Residual stomach contents are checked by aspirating the gastrostomy tube through a syringe. If the residual stomach contents are substantial, they are replaced by the same amount of new formula. When the stomach residue is more than 10 mL in the infant, the nurse should first remove the residue from the stomach before administering the new formula. This should be done before administering the formula to prevent overloading the stomach. Positioning the infant in the Fowler's position is not an appropriate intervention in this situation. This intervention is useful to facilitate gastric emptying in the infant. The quantity of the formula has to be decreased by an equal amount of residual content, 25mL in this case. This needs to be done to prevent overloading, which may cause regurgitation and increased danger of aspiration. If the residual contents are large, then the feeding should be delayed for a short time to prevent aspiration.)

Which sites are preferred for intravenous (IV) infusion in children? Select all that apply.

Scalp veins; Subclavian veins; Dorsal hand veins (The recommended sites for intravenous infusion in children include scalp veins, subclavian veins, and dorsal hand veins. These sites are ideal for IV infusion because they are more accessible, and the walls of these veins are flexible and sustainable. Plantar foot veins are difficult to access and are very thin walled. The internal jugular vein is difficult to access and is not a preferred site for IV infusion.)

The nurse is monitoring a child being treated for severe constipation. The nurse, upon reviewing the arterial blood gas report, finds that the child has developed metabolic acidosis. Which treatment would have caused this complication in the child?

Sodium biphosphate and sodium phosphate solution (Metabolic acidosis is a complication commonly observed in children who are administered a fleet enema with composition of sodium biphosphate and sodium phosphate solution. The development of metabolic acidosis is due to the osmotic action of the sodium biphosphate and sodium phosphate solution. NuLytely solution administration takes place to cleanse the intestines before bowel exam procedures, such as colonoscopies. It is a safe procedure and does not cause metabolic acidosis. Magnesium citrate solution is a laxative, which causes evacuation of the bowels by water retention in the intestines. It also reduces the risk of electrolyte imbalance. An oral polyethylene-glycol lavage solution is used to cleanse the bowels before performing bowel exam procedures, and has no relation to metabolic acidosis.)

The nurse observes leakage at the intravenous (IV) site in a child who is on IV therapy. The nurse also observes tense tissue turgor and blanched skin at the IV site. What does the nurse infer from these findings?

The infant has infiltration. (Infiltration refers to the accumulation of the medication at the injection site. The signs of infiltration are leakage at the IV site, rigid tissue turgor, and pale skin at the IV site. The child also experiences pain or a burning sensation at the site due to infiltration. IV medications can also cause phlebitis, but the manifestations of phlebitis include redness and other signs of inflammation at the IV site. IV medications do not cause hyperthermia in children. Hyperthermia occurs in the infant due to drug reactions, trauma, or high environmental temperature. A rapid rate of infusion of an IV solution can cause fluid overload in the infant. Fluid overload increases the pulse rate and blood pressure in the infant.)

While caring for an infant, the nurse finds that the infant has sunken fontanelle. What does the nurse infer from this finding?

The infant may have dehydration. (Decreased amounts of water and essential fluids are the major cause of sunken fontanelle. Therefore, a sunken fontanelle indicates dehydration in the infant. Tachycardia is the first sign of shock or body stress in an infant. A sunken fontanelle does not indicate tachycardia in an infant. Hyperthermia may be due to drug reactions, trauma, or high environmental temperature. A bulging fontanelle indicates increased intracranial pressure.)

Which of the following statements are appropriate when administering medications to children? Select all that apply.

The nurse should plan additional time for administering medications to children; The nurse will find that resistive behavior to taking medications is at a peak with toddlers; The nurse will find that chewable tablets are preferred for preschool-age children. (Children may be uncooperative, so extra time must be allowed. Resistance is higher with toddlers, so nurses must plan for this. Elixirs and chewable tablets are preferred for preschoolers. The nurse should not leave medications with an adolescent to take at a later time. The nurse should always be the professional who gives the injection. This should not be delegated to the parents.)

The nurse is caring for a patient receiving intravenous (IV) medication. Why does the nurse need to monitor the IV site? Select all that apply.

To check for infiltration; To check for inflammation; To check for patency of the IV line ( Pale skin and leakage at the IV site are some of the characteristics of IV infiltration. Therefore, the nurse should monitor the IV site to check if the patient has infiltration. Signs of inflammation around the IV site indicate that the patient is developing phlebitis. The patency of the IV line determines whether the flow through the IV line is maintained or obstructed. A slow rate of infusion causes clot formation that obstructs the patency of the IV line. The effectiveness of the drug is not determined by the site of drug administration. The effectiveness depends on the route of drug administration. The size of the cannula is predetermined and depends on the flow rate of the fluid or the medication delivered via the IV route.)