PNE 136/PrepU 31, 32, 33 & 34

The nursing is teaching parents how to administer a prescribed otic medication for a 2-year-old toddler with otitis media. Which statement will the nurse include in the teaching? "Massage the area posterior to the affected ear after instilling the drops." "Place your toddler on the stomach after instilling the drops." "Be sure the ear drops are at room temperature before administering." "Pull your toddler's ear up and back before you give the ear drops."

"Be sure the ear drops are at room temperature before administering." Explanation: Otic administration refers to delivering medicine into the ear canal. To limit pain and discomfort, the ear drops should be room temperature when administered. If necessary, the container can be rolled between the palms to help warm the drops. When doing this, the ear of the child who is 2 years and younger should be pulled down and back. The ear of the child who is 3 years and older should be pulled up and back. The child should be placed supine or side-lying with the affected ear exposed, drops instilled, area anterior massaged to promote passage of the medication into the ear canal, and have the child remain in this position for a few minutes.

The nurse is conducting a health assessment of a 6-year-old girl with spinal bifida. During the interview, the girl keeps interrupting and shouting to get her mother's attention. The mother instantly responds to every interruption and attempts to placate her with promises of a trip to the ice cream store. Which response by the nurse would be most appropriate to address the mother's response to her daughter's demands? "Does your daughter interrupt you like that on a regular basis? "She is certainly demanding, isn't she?" "How do you feel when your daughter interrupts you?" "Aren't you embarrassed by your daughter's behavior?"

"How do you feel when your daughter interrupts you?" Explanation: It is common for parents of children with a chronic condition to spoil their children and allow them to have anything that they wish. The nurse should try to elicit the mother's feelings about the girl's behavior in order to open a dialogue about appropriate discipline. The open-ended question is the best way to gather information and evaluate the mother's feelings. Simply commenting about her behavior is not helpful. Asking a yes or no question is less likely to elicit the necessary information.

Which is a common adolescent statement to the nurse by a child who has a chronic condition? "I miss my friends and going to the movies." "I like my tutor who is helping me with my math." "I get balloons when I am in the hospital." "My extended family visits me when they are off of work."

"I miss my friends and going to the movies." Explanation: Adolescents with chronic conditions often feel isolated, especially when they are in the hospital. Friends are very important to the adolescent and normal activities are greatly missed. Getting balloons does not replace the interactions with friends. Having a tutor further signifies the isolation of being away from school. Family visiting when they can is also important, but not as important to the adolescent as friends.

Which statement made by the mother of an infant who is born with severe intellectual disability indicates an appropriate understanding of her infant's long-term needs? "I realize that my child will need all of my attention for the rest of her life." "I understand my child will grow up but needs to develop as much independence as possible." "I know that once my child begins school, she will catch up with other children." "I realize that my child will need close supervision once she becomes sexually active."

"I understand my child will grow up but needs to develop as much independence as possible." Explanation: Children who are physically challenged or intellectually disabled need to have independence so they can grow to achieve as much as is possible.

A mother of a newborn brings her child to the well-child clinic the week after birth. The mother asks the nurse if the child will get any "shots" at the next appointment. The best response from the nurse would be: "No, your child will not get any shots at the 2-month appointment." "Yes, your child will get 2 shots next time; they will be the HPV and the MCV4, and they will go in the arm." "Yes, your child will get 3 shots next time. They will be the polio vaccine (called IPV), Haemophilus influenza B vaccine (called Hib), and hepatitis B vaccine. They will be given in the thigh." "Yes, your child will get shots at the next appointment."

"Yes, your child will get 3 shots next time. They will be the polio vaccine (called IPV), Haemophilus influenza B vaccine (called Hib), and hepatitis B vaccine. They will be given in the thigh." Explanation: In older children, the deltoid muscle and the ventrogluteal are acceptable sites. For infants under walking age, use the vastus lateralis for IM injections.

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. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1 Instruct the child to gently close the eyes 2 Wipe any excess medication from the skin 3 Place the prescribed number of drops into the lower eyelid 4 Retract the lower conjunctival sac 5 Place the child in the supine position, slightly hyperextending the neck with the head lower than the body

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 Explanation: After performing the rights of medication administration, the nurse would place the child in the supine position, slightly hyperextending the neck with the head lower than the body. Next, the nurse would retract the lower eyelid and instill the drops. The child would then gently close the eyes and the nurse would remove any excess medication.

The nurse is preparing to administer an oral dose of metoclopramide to a 5-year-old child who weighs 40 lb (18.2 kg). The prescription reads metoclopramide 0.8 mg/kg/day to be given in 4 oral doses. How many milligrams of metoclopramide would the nurse give per dose? 3.65 mg per dose 14.60 mg per dose 8.00 mg per dose 18.20 kg per dose

3.65 mg per dose Explanation: To calculate the does, use the client's weight in kilograms. Multiply 0.8 mg by 18.2 kg, which equals 14.6 mg per day for the client's weight. Then, divide 14.6 mg by 4, the number of doses per day , to arrive at 3.65 mg per dose.

A 5-year-old child is to receive long-term IV antibiotics. The mother is concerned about what type of administration method will be used. Which medication administration route may be the most easily accepted? An intraosseous line in the left lower leg A Hickman catheter in the right upper chest A port in the left upper chest A peripherally inserted central catheter (PICC) line in an antecubital space

A peripherally inserted central catheter (PICC) line in an antecubital space Explanation: If IV antibiotic therapy is going to be needed for an extended period of time, a type of longer-term device needs to be used as opposed to a peripheral IV. A peripheral IV would need to be changed often and the risks of dislodgement or inflammation are much greater. Peripherally inserted central catheters (PICCs) are placed in the upper arm under ultrasound guidance. If maintained properly they can remain for many months. This means no IV sticks for the time the child would need IV therapy. It also leaves the hands free to use. A port must be surgically implanted into the child's chest. It can remain for many months. This would not be warranted for a one-time treatment of antibiotic therapy. A Hickman catheter is inserted via sterile procedure by a surgeon. This catheter is placed near the heart and has an increased risk of infection. An intraosseous line is not a route for long-term administration. It is used for emergent situations.

The nurse is preparing to give an oral medication to an 11-year-old client. Which of the following is the best approach for the nurse to take? Introduce a bottle first, to prepare the client for swallowing. Use abstract rationales when explaining the need for the medication. Provide preparation through play. Allow independence from the parent in the process of medication administration.

Allow independence from the parent in the process of medication administration. Explanation: Allowing a client in middle childhood independence from the parent is an appropriate approach. Abstract rationales are too advanced for this age group and are better suited to adolescents. Allowing preparation through play is better suited to a child in early childhood. Introducing a bottle is better suited for an infant.

The nurse is administering a liquid medication to a 3-year-old using an oral syringe. Which action would be most appropriate? Keep the child's hand away from the oral syringe when squirting the medication. Direct the liquid toward the anterior side of the mouth. Allow the child time to swallow the medication in between amounts. Give all of the drug in the syringe at one time with one squirt.

Allow the child time to swallow the medication in between amounts. Explanation: When using an oral syringe to administer liquid medications, give the drug slowly in small amounts and allow the child to swallow before placing more medication in the mouth. The syringe is directed toward the posterior side of the mouth. The toddler or young preschooler may enjoy helping by squirting the medication into his or her mouth

Chapter 32

Chapter 32

The nurse enters the room to give a subcutaneous injection of insulin to a 6-year-old child with diabetes. What is the best method of medication administration? Announce to the child that it is time for insulin and give the injection matter-of-factly. Ask the child where the child would like to have the injection. Tell the child that the client is to remain very still and not cry. Ask the child if it is okay to give the injection now.

Ask the child where the child would like to have the injection. Explanation: Asking the client to choose where to receive the injection gives a degree of control. Announcing that it is time for the medication does not give any sense of control to the child. Asking permission to give a medication to a child is not appropriate—a child should not be given the opportunity to decline a medication. It is not appropriate to tell a child not to cry during a painful procedure. The child should be given permission to yell out or cry if he or she feels the need to.

A 5 year-old client is prescribed an oral antibiotic. What should the nurse do when preparing to give the child this medication? Assess if the child is able to swallow pills. Give the medication with a small glass of water. Inform the child that an injection will be used if they can't take the pill. Plan the dose to be given before the next meal.

Assess if the child is able to swallow pills. Explanation: Many children do not have enough coordination to swallow tablets or pills until they are 6 or 7 years of age. Children younger than 9 years of age often have difficulty swallowing tablets. This can make getting a child to agree to try an oral medication difficult. The nurse needs to check to see if the child can swallow pills before providing the oral medication. Giving a small glass of water with the medication will not determine if the child can swallow an oral medication. Giving the oral medication at the time of the next meal does not necessarily mean that the child will be able to swallow the oral medication. The nurse should not threaten to give the medication with an injection

Which assessment is most important for determining an accurate dose of a pediatric medication? Height Body mass index Age Body surface area

Body surface area Explanation: Body surface area (BSA) is the most accurate measure for dosing medications for children. In pediatrics, there are no standard amounts of a drug given per age; rather, dosage is based on weight using an established amount of the drug per body weight. Body mass index is not considered when determining pediatric medication dosing.

When considering the developmental pharmacokinetics of children, what accurately describes the factors that affect medication distribution in children? Gastric pH is high in neonates; neonates and infants have increased skin permeability and decreased muscle oxygenation. Children have a higher proportion of total body water, a lower proportion of body fat, and an immature blood-brain barrier. Glomerular filtration and tubular secretion are reduced at birth, and there is gradual increase in renal function, with adult values reached during the first 1 to 2 years of life. The liver and enzymes in a child are immature.

Children have a higher proportion of total body water, a lower proportion of body fat, and an immature blood-brain barrier. Explanation: Children have a higher proportion of total body water, a lower proportion of body fat, and an immature blood-brain barrier. These all affect the distribution of medication in a child's body. Glomerular filtration and renal function affect the elimination of medication in a child's body. Liver and enzyme immaturity affect the metabolism of medication in a child's body. Gastric pH is high in neonates; neonates and infants have increased skin permeability; and decreased muscle oxygenation affect the absorption of medication in a child's body.

The nurse is preparing to administer a PO medication to a 6-year-old in the hospital for an exacerbation of asthma. The nurse notes that the child is due for an oral dose of lansoprazole in 1 hour. What is the most important action for the nurse to take before administering this medication to the client? Prepare to give the medication as ordered in 30 to 90 minutes. Obtain parental permission to administer this medication. Ask the mother how she usually gives this medication to the client. Clarify the order, since there is no apparent link between the client's diagnosis and the medication.

Clarify the order, since there is no apparent link between the client's diagnosis and the medication. Explanation: There is no clear link between this client's diagnosis and the lansoprazole administration. The nurse should clarify a medication order that does not have a clear link to the client's diagnosis before giving the medication. Asking the mother how she usually gives the medication is a good idea; however, it is not the priority nursing action in this scenario. Parental permission is not required to administer this medication. Consent to treat is signed upon admission to the hospital.

A child is receiving intravenous fluids for dehydration. The nurse notes coarse breath sounds and increased pulse and blood pressure. What does the nurse do first? Request a chest X-ray for evaluation. Assess intake, output, and weight. Discontinue the IV infusion. Contact the health care provider.

Discontinue the IV infusion. Explanation: Signs of fluid overload are those of congestive heart failure and include coarse breath sounds, increased pulse rate, and increased blood pressure. These are not symptoms of extravasation because this would be swelling of fluid around the IV site. The nurse would need to stop the IV infusion, then assess weight, intake, and output. The nurse would then contact the health care provider.

When preparing to administer a vaccine to a 3-year-old child, what actions by the nurse are appropriate? Select all that apply. Discuss with the child's parent the use of therapeutic hugging during the injection. Chat with the child during the injection. Utilize a restraint board to help hold the child still. Explain the procedure to the child in simple terms. Require the child to remain silent during the injection.

Discuss with the child's parent the use of therapeutic hugging during the injection. Chat with the child during the injection. Explain the procedure to the child in simple terms. Explanation: Restraining a child during a painful procedure can increase the child's stress. Atraumatic care suggests using positions of comfort such as therapeutic hugging to help decrease the child's stress. The use of distraction techniques such as singing a song or counting can help decrease the child's stress. Requiring the child remain silent may cause an increase in the child's fear. Providing information to the child at a level the child is able to understand is recommended.

A toddler requires 1.5 ml of an antibiotic given intramuscularly (IM). How will the nurse administer this medication? Administer the antibiotic IM in the rectus femoris. Divide the dose. Administer 0.75 ml IM in each vastus lateralis. Seek an order for an oral form of the antibiotic. Reduce the volume of the dose using less diluent than recommended to prepare the antibiotic for IM injection.

Divide the dose. Administer 0.75 ml IM in each vastus lateralis. Explanation: The recommended amount of solution a toddler should receive in one IM injection should not exceed 1 ml. Dividing the dose is necessary even though two injections will cause additional stress. These could be given simultaneously by two nurses. Seeking an oral route could be explored, but may not be feasible. The manufacturer's directions regarding the amount of diluent should be followed to ensure safety.

A child is prescribed multiple intravenous medications. Which nursing action demonstrates the best practice to maintain medication safety? Give the medications together to decrease administration time. Flush the intravenous line between each medication. Use 5% dextrose in water (D5W) for medication administration. Ensure that two nurses check the health care provider orders.

Flush the intravenous line between each medication. Explanation: Two nurses are not necessarily needed to transcribe or review health care provider orders. Pharmacists review all pediatric medication orders for accuracy. Diluents and fluids should always be checked for compatibility with the medications. Thus, the best practice when giving multiple IV medications to a child is to flush the IV line between each medication.

The nurse is caring for a toddler diagnosed with iron deficiency anemia and prescribed an iron supplement. What would the nurse include in the educational plan for the parents? Select all that apply. Give the iron supplement with a liquid or food high in vitamin C (such as orange juice/oranges) Iron supplements may cause dark stools, so monitor for this as an expected finding Offer the toddler an iron supplement dissolved in milk or yogurt Encourage the toddler to consume high carbohydrate meals and snacks Offer the toddler snacks such as bananas, peas and potatoes

Give the iron supplement with a liquid or food high in vitamin C (such as orange juice/oranges) Iron supplements may cause dark stools, so monitor for this as an expected finding Explanation: Iron supplements are best given with a food or liquid high in vitamin C because it enhances iron absorption. The toddler's stools will be dark in color as this is an expected finding for a child taking iron supplements. The child should avoid excess cow's milk because this tends to cause the child to consume too little iron and not be hungry for iron rich foods. Snacks and foods high in carbohydrates are typically low in iron, so the nurse would not encourage these types of foods. Bananas, peas and potatoes are high in potassium, not iron.

What method would the nurse use to teach an 8-year-old client how to swallow medications? Crush the tablet and mix with honey. Place the tablet in applesauce to ease swallowing. Have the child place the tablet on the tip of the tongue. Have the child practice swallowing an ice chip.

Have the child practice swallowing an ice chip. Explanation: Hiding the pill in applesauce or crushing it may help the child swallow it easier, but it does not teach the child how to swallow a pill. The nurse should have the child practice swallowing a small piece of ice, as it will melt and not get stuck in the throat. It is best to put the pill as far back on the tongue to make it easier to swallow

When caring for an adolescent with a disability, it is best for the nurse to promote which of the following? Push the child to perform self-care independently. Have the child socialize with peers with and without disabilities. Have the child socialize with peers who have disabilities. Have the child socialize with peers who are free of disabilities.

Have the child socialize with peers with and without disabilities. Explanation: An older child benefits from social interaction with peers with and without disabilities. Adolescents should be encouraged to join in age-appropriate activities. To improve their appearance, it may be necessary to help them with dressing or using makeup.

The nurse is caring for an 8-year-old girl who requires medication that is only available in an enteric tablet form. The nurse is teaching the mother how to help the girl swallow the medication. Which statement indicates a need for further teaching? "We cannot crush this type of pill as it will affect the delivery of the medication." "I can encourage her to place it on the back of her tongue." "I can pinch her nose to make it easier to swallow." "We can place the tablet in a spoonful of applesauce."

I can pinch her nose to make it easier to swallow." Explanation: The mother should be advised to never pinch the child's nose as it increases the risk for aspiration. The other statements are correct.

A toddler is prescribed amoxicillin for bilateral otitis media. The parent reports that the toddler refuses to take the oral medication. The nurse knows that more education is needed when the parent makes which statement? "I will shake the medication well, and draw up the amount prescribed. I will allow my toddler to suck in the medication while I hold him." "I will shake the medication well, and draw up the medication to the top of the syringe. My spouse and I will hold our toddler down and force the medication down his throat." "I will shake the medication well, and draw up the amount prescribed in the syringe you gave me. I will hold my toddler upright so he does not choke, and I will squirt the medication along the gum line." "I will shake the medication well, and draw up the amount prescribed in the medicine spoon you gave me. I will hold my toddler upright so he does not choke, and I will let him drink the me

I will shake the medication well, and draw up the medication to the top of the syringe. My spouse and I will hold our toddler down and force the medication down his throat." Explanation: The objective of administering oral medications is to administer the entire dose to the toddler while creating the least aversion to the medication as possible. No force should be used. Allowing the toddler to take the medication slowly from a medicine spoon or syringe is one way to reduce aversion.

A school-aged child will have an intravenous line inserted. His mother asks if he could have this placed in his left hand so that he can do homework. What is the nurse's best response? "Let's take a look at the left hand first." "It would be better for him to wait and be surprised." "It's a doctor's decision on the best site." "I doubt it; most children have better veins on the right."

Let's take a look at the left hand first." Explanation: If at all possible, children should be allowed a choice of intravenous sites to offer them a sense of control.

As the nurse prepares to administer a medication to a preschooler, the nurse realizes that the child is extremely underweight for age. What action would the nurse take? Call the child's health care provider and alert the provider to the dosage error. Give the child the prescribed dose, because dose is determined by nomogram, not weight. Give the child one-half the prescribed dose. Measure the child's height and weight, and check whether the dose is correct for the child.

Measure the child's height and weight, and check whether the dose is correct for the child. Explanation: Before any medicine is administered, it should be confirmed that the dose is correct for the child's weight and height because of the great variability in these areas. Medication dosages can be prescribed by body weight and by body weight and height. The child's weight is always converted to kilograms. If the medication is prescribed by body weight the nurse would need to weigh the child. This measurement allows for the drugs to be prescribed by a 24 hour period (mg/kg/day) or by the dose (mg/kg/dose). If the weight and height are needed, the drugs are calculated by body surface area (BSA). This is plotted on a nomogram. This is used most often for chemotherapeutic drugs. The nurse should not adjust the dose or call the health care provider until the weight is obtained and the correct dosage needed is verified.

The nurse is administering a crushed tablet to an 18-month-old infant. What is a recommended guideline for this intervention? Mix the crushed tablet with the infant's cereal. Place the crushed tablet in the infant's formula. Crushed tablets should only be mixed with water. Mix the crushed tablet with a small amount of applesauce.

Mix the crushed tablet with a small amount of applesauce. Explanation: If a tablet or capsule is the only oral form available for children younger than 6 years, it needs to be crushed or opened and mixed with a pleasant-tasting liquid or a small amount (generally no more than a tablespoon) of a nonessential food such as applesauce. The crushed tablet or inside of a capsule may taste bitter, so it should never be mixed with formula or other essential foods. Otherwise, the child may associate the bitter taste with the food and later refuse to eat it.

The nurse educator is teaching the class of nurses about infusion control in children. The nurse knows that more education is needed when the student nurse states: "It is important to accurately document IV fluid intake on any infant/child undergoing IV therapy." "No special pumps are needed for the pediatric client; I can use the same one that we use with adult clients." "The rate of infusion for infants and children must be carefully monitored, and an infusion control device must be used." "To avoid overloading the circulation and inducing cardiac failure, the IV drip rate must be slow for the infant or small child."

No special pumps are needed for the pediatric client; I can use the same one that we use with adult clients." Explanation: Pediatric IV medications can be given directly into the IV tubing or via volume control chamber, syringe pump, or a volume control chamber. They are used to avoid overloading of the cardiopulmonary system. The amount of fluid needs to be monitored and accurately documented to avoid overloading the infant/child's circulation

A nurse who works with pediatric clients will use what device to estimate body surface area (BSA) to calculate medication dosages? Calculator Anagram Sonogram Nomogram

Nomogram Explanation: A nomogram to estimate body surface area (BSA) is used when calculating dosages for pediatric clients. A nomogram is a graph with three columns. The left column is the height. The middle column is the surface area and the right column is the weight. The nurse will measure the child's height and weight. On the graph, a line will be drawn across to connect the height and weight. The point where this intersects on the middle column is the BSA. A calculator is used often to calculate pediatric medications but it cannot calculate BSA. It determines dosage by weight. A sonogram is an ultrasound examination. An anagram is a word, phrase, or name formed by rearranging the letters from another word.

While working in the emergency room, the nurse receives a call that a 3-year-old child sustained extensive burns in a house fire. Assuming all of the following actions are included in the standing burn-care protocol, which action should be the nurse perform first? Insert a nasogastric tube to empty the stomach. Obtain a weight. Ask the child to drink a glass of milk. Give a tetanus toxoid injection.

Obtain a weight. Explanation: A burn victim will require large amounts of fluid hydration to replace fluid losses. Obtaining a weight provides a base for calculating the fluid that will need to be replaced. Nasogastric tube placement and/or drinking milk are not actions to take at this point. Tetanus can be given later and is not critical to active management.

A nurse is preparing to administer a prescribed dose of medication to a preschool-aged child. Assessment reveals that the child is underweight. Which action would the nurse do next? Give the child the prescribed dose. Call the provider and alert to the dosage error. Obtain the child's current height and weight and check the dose. Give the child one-half the ordered dose.

Obtain the child's current height and weight and check the dose. Explanation: Before administering any medication to a child, confirm that the dose prescribed is correct for the child's weight or body surface area. The nurse should not give the child the prescribed dose or one-half the ordered dose. A dosage error has not occurred. The nurse is just calculating the dose according to the child's current correct weight

A nurse is administering ear drops to a 7-year-old girl. What should the nurse do? Hold the child's head in the sideways position while counting to 5 to ensure the medication fills the entire ear canal. 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. Warn the child that the drops will hurt.

Pull the pinna of the ear up and back to straighten the external ear canal. Explanation: Remind the child ear drops can feel odd, as if someone were tickling the ear. Ear drops must always be used at room temperature or warmed slightly as cold fluid, such as medication taken from a refrigerator, does cause pain and may also cause severe vertigo as it touches the tympanic membrane. If the child is older than 2 years, pull the pinna of the ear up and back. Instill the specified number of drops into the ear canal. Hold the child's head in the sideways position while you count to 60 to ensure the medication fills the entire ear canal.

To give eardrops to a 4-year-old child, what would be the best technique to use? Pull the pinna of the ear up and back. Pull the pinna of the ear downward. Lift the pinna of the ear down and back. Press the pinna of the ear forward.

Pull the pinna of the ear up and back. Explanation: Pulling the pinna upward and back straightens the ear canal in the child older than 3 years of age. To administer otic drops to a child younger than 3 years, the pinna would be pulled downward and back. Pressing the pinna of the ear forward or downward would occlude the ear canal.

A father believes his 2-year-old son is frightened by seeing an intramuscular (IM) medication injected into his thigh and requests that the child's "butt" be used. What will be the nurse's response? "Because he is 2 years old, this will be OK." "Because he is still in diapers, the thigh is a better choice." "The muscle in his butt is not well enough developed to receive this injection until he has walked for 1 year." "The medication will be better absorbed from his thigh."

The muscle in his butt is not well enough developed to receive this injection until he has walked for 1 year." Explanation: Muscle development follows use, and 1 year of walking allows for full development of the gluteus and less likelihood of injury to the sciatic nerve. Since most children do little walking at 12 months, it is not likely the child has been walking for a year. The other explanations do not address muscle development or are inaccurate statements

The nurse is preparing to start an intravenous (IV) line on a 4-year-old client who is dehydrated. The client tearfully states, "Please do not hurt me. I do not like needlesticks." Which action will the nurse perform first? Request a prescription for lidocaine/prilocaine cream from the primary health care provider. Delay performing the procedure until the client is taking the afternoon nap. Do not start the IV and encourage the client to drink large amounts of oral fluids. Recommend the client's parent hold the client in a hugging position during the procedure.

Request a prescription for lidocaine/prilocaine cream from the primary health care provider. Explanation: The nurse desires to provide the child with atraumatic care, which is therapeutic care that minimizes or eliminates the psychological and physical distress experienced by children and their families in the health care system. To provide atraumatic care, the nurse will first request a lidocaine/prilocaine cream to apply to the site before inserting the IV to numb the area. The nurse may request the parent or another health care provider assist in holding the child during the procedure. The nurse would not attempt to perform the procedure while the child was napping or delay starting the IV as the child is dehydrated and needs hydration therapy.

A child with gastroenteritis has been unable to keep oral medication down. What nursing intervention would be appropriate for this client? Give an antiemetic prior to giving oral medications. Request an intravenous form of the medication. Hold all medications until the vomiting stops. Place the child on NPO status.

Request an intravenous form of the medication. Explanation: Absorption is the transfer of the drug from its point of entry into the bloodstream, and vomiting and diarrhea interfere with absorption because the drug does not remain in the gastrointestinal tract long enough to be absorbed. Distribution is not affected by vomiting and diarrhea, as it involves movement of the drug through the bloodstream. Metabolism involves conversion of the drug into an active or inactive form, and is unaffected by gastroenteritis. Excretion is the elimination of the drug from the body, usually through the kidneys. This is also unaffected by vomiting and diarrhea.

A nurse is preparing to administer a prescribed medication to a hospitalized 4-year-old child. Which action would the nurse use to identify the child? Scan the barcode on the child's armband. Ask the child to tell the nurse their name and age. Tell the child to state their address and nickname. Say the child's name and ask if it is correct.

Scan the barcode on the child's armband. Explanation: The nurse should read or scan the bar code on their identification arm bands and compare them with the medication sheet or electronic record. When asked what is their name, children cannot be depended on to reply with their correct name. Anxious to please, a preschooler will answer the question, "Are you Johnny Jones?" with "yes." The child may also agree with any other name the nurse states. Stating a nickname would not correctly identify the child.

The nurse teaches the mother of a 2-year-old child how to instill antibiotic otic drops. The mother indicates understanding of the skill when she takes which action? She pulls up and forward on the earlobe before instilling the drops. She pulls up and backward on the earlobe before instilling the drops. She pulls down and outward on the earlobe before instilling the drops. She pulls down and backward on the earlobe before instilling the drops.

She pulls down and backward on the earlobe before instilling the drops. Explanation: In children younger than 3 years of age, the pinna must be pulled down and outward to visualize the ear canal. In children older than 3 years of age, the pinna is pulled up and back to visualize the ear canal.

The nurse is providing discharge instructions to the parent of a child newly diagnosed with a chronic illness. How will the nurse know the parent understands the home care instructions? The parent can verbalize the instructions. The parent states medications will be given as instructed. The parent states understanding of the instructions. The parent asks appropriate questions.

The parent can verbalize the instructions. Explanation: Education is learned knowledge. When the parent can verbalize the instructions given, the nurse will know knowledge was obtained. When the parent asks questions about the instructions, it may mean there is a lack of knowledge or a miscommunication. The parent stating understanding the instructions does not mean the nurse actually knows if the parents understand the instructions. This could mean the parents will go home and not be able to perform treatments or give medications as prescribed.

The nurse is talking to a 12-year-old sibling of a child with a chronic condition in the waiting room at the pediatrician's office. The sibling states, "I hate coming here and waiting. It is such a long car ride. I just want to get home." Which nursing response is best? "How can I make you happy?" "I understand what you mean." "That's too bad you feel that way." "That must be hard for you."

That must be hard for you." Explanation: Stating "That must be hard for you" accepts the sibling's feelings and potentially elicits more information. It is a method of therapeutic communication. Stating that the nurse understands how the sibling feels or saying that's too bad closes communication. It is nice to attempt to raise the child's spirits but it changes the topic of the way the sibling is feeling.

The nurse is instructing a parent on administering ear drops to a 6-year-old. Which parental action demonstrates an understanding of teaching? The parent administers the medication following removal from refrigerator. The parent shakes the medication prior to administration. The parent allows the child to instill the medication. The parent has the child sit down and pulls the pinna upward and back

The parent has the child sit down and pulls the pinna upward and back Explanation: The nurse should pull the pinna upward and back for children 3 years of age and older. The nurse should pull the pinna downward and back for children younger than 3 years of age. Medication should not be instilled cold and should not be heated in the microwave. A 6 year old is not able to instill ear drops independently.

The nurse is providing discharge education to the parents of a 2-year-old who will be taking amoxicillin orally at home. The nurse would include which statement in the teaching? "Crush the pills and mix with applesauce when giving the medication." "Give the medication until your child has no symptoms." "Mixing the medication with milk will help." "Use a dosing cap to measure the dosage."

Use a dosing cap to measure the dosage." Explanation: When talking to parents about giving medicine, stress that if a medicine comes supplied with a dosing cap, it is best to use that to measure the correct dose (Pham et al., 2011). If there is no dosing cap, then an oral medicine syringe or dropper are the next best methods to measure liquid medicine because kitchen teaspoons are rarely exactly 5 ml. Antibiotics need to be taken for the full course, not until symptoms subside. Mixing the medication with a drink or in food makes it difficult to determine how much the child has taken if the child refuses to finish it all. Amoxicillin comes in a liquid form, so crushing the pills is not appropriate.

The nursing student identifies which technique as the correct one to use when giving oral medications to an infant? Use a dropper and squirt the liquid quickly into the back of the infant's mouth. Use a dropper and let it rest on the infant's tongue when squirting the medicine. Allow the child to lay flat while giving the liquid medication to relax the child. Use a dropper and slowly inject the liquid into the side of the infant's mouth.

Use a dropper and slowly inject the liquid into the side of the infant's mouth. Explanation: When giving liquid medication to an infant or child, the nurse should never administer it while the child is flat. Doing so could cause a child to aspirate. The nurse uses the dropper by placing it so the fluid flows slowly into the side of the child's mouth. The nurse should make sure the end of the syringe rests at the side of the infant's mouth to help prevent aspiration as well.

Which action should the nurse take to ensure an intravenous infusion will be administered safely to young child? Use an infusion pump for administration. Use a rolled pillowcase instead of a hard arm board. Hang the infusion bag no higher than 4 ft above the infant's head. Use a large-bore needle to prevent plugging.

Use an infusion pump for administration. Explanation: Infusion pumps are required in most settings for infants and children receiving IV fluids and when giving potent medications and always for small children because they regulate the flow accurately to a few drops per minute. Overloading of IV fluid in infants can be prevented by use of fluid chambers, devices that allow only 50 to 100 ml of fluid into the drip chamber at a time. With these in place, even if the pump fails, only the amount of fluid in the drip chamber will be allowed to enter the child's circulation, not the entire contents of the bag suspended above the child's head. A large-bore needle will not ensure that intravenous fluids will be administered safely to an infant. Using a rolled pillowcase instead of a hard arm board also will not ensure that intravenous fluids will be administered safely to an infant. The height of the infusion bag will not ensure that fluids will be administered safely to an infant.

The nurse is preparing to administer an IV antibiotic to a 10-year-old child. After calculating the recommended dose with the client's weight, the nurse discovers the ordered dose exceeds the safe dose range in a pediatric drug reference. The medication has been given to the child at this dose for three days. Which of the following should the nurse's next action be? Give the ordered dose since the client has been receiving that dose for 3 days. Call the pharmacy. Ask the client's parents if this dose has been given all week. Verify the dose with the prescribing practitioner.

Verify the dose with the prescribing practitioner. Explanation: Medication calculations should always be checked before giving the dose. When a medication dose is found to be outside of the safe dose range, the dose should be verified with the prescribing practitioner. Doses that exceed the recommended range should always be verified, even if they have been given before. The parents did not prescribe this medication. Even if the medication had been given for three days, it does not make the dose correct. Calling the pharmacy can only verify if the dose is out of the safe range. The pharmacy did not prescribe the medication, nor do they know the medical background of the client.

The nurse is providing teaching for parents on how to administer ointment to their son's eyes. Which response indicates a need for further teaching?

We should stand or sit behind him as he lies down.

David, age 2, is diagnosed with stomach flu and is suffering from vomiting and diarrhea. What is the most important factor in determining the correct dosage for his infection? body surface area adult dosage past experience age

body surface area Explanation: A drug dose for a child can be determined by using the standard formula for finding the body surface area of the child. The ratio of the body surface area to weight is inversely proportional to its length. Body surface area also can be determined by using a nomogram. Drug dosages cannot be based on age or memorized because child weights may vary considerably. Child dosage cannot be based on adult dosage, because a child's body is small and immature.

The nurse is caring for a 2-year-old girl with spina bifida. The mother confides that she is depressed and feels that she has somehow contributed to her daughter's condition. Her guilt is compounded by her mother-in-law's accusations that the mother's poor nutrition during pregnancy caused the spina bifida. What should the nurse tell the mother? "Your feelings are normal, and it is important to talk about this." "It's not good to feel guilty. What do you think you did wrong?" "Let's talk about ways you could learn to ignore her comments." "You didn't do anything wrong. Don't be too hard on yourself."

Your feelings are normal, and it is important to talk about this." Explanation: A parent's belief that he/she somehow did something wrong that contributed to the child's chronic condition is normal. It is important to encourage the mother to talk about her feelings and acknowledge their normalcy. Telling the mother she didn't do anything wrong dismisses her concerns and would likely put an end to the conversation. Asking her what she thinks she did wrong might potentially validate her fears. Suggesting she simply ignore her mother-in-law's comments is not helpful and does not address the mother's concerns.

The nurse is preparing a subcutaneous insulin injection for a preschooler. How and where should the nurse administer the insulin? at a 45- to 90-degree degree angle into the rectus femoris at a 45- to 90-degree angle into the elevated tissue of the upper arm at a 45-degree angle into the deltoid of the upper arm at a 90-degree angle into the vastus lateralis

at a 45- to 90-degree angle into the elevated tissue of the upper arm Explanation: Subcutaneous administration distributes medication into the fatty layers of the body. It is used for insulin administration. Preferred subcutaneous sites include anterior thigh, buttocks, upper arms, and abdomen. The rest of the sites are intramuscular ones and not appropriate for insulin administration.

A woman has just been told that her 5-year-old has leukemia. She says, "How can this be?" The mother is exhibiting signs of which of the following? guilt grief overprotection denial

denial Explanation: When anyone suffers a loss, a grief reaction occurs. This is true when a parent learns of a diagnosis of a chronic illness. Denial is usually the first reaction to the diagnosis and is exemplified when a parent states, "How could this be?" or "Why my child?"

The site most often used when administering a medication using the intradermal route is the: forearm. deltoid. abdomen. thigh.

forearm. Explanation: Intradermal injections deposit medications just under the epidermis. They are most often used for tuberculosis screening and allergy testing. The forearm is the site most often used. The anterior thigh, lateral upper arms, and abdomen are the preferred sites for subcutaneous administration. The deltoid, vastus lateralis and the ventrogluteal are the preferred sited for intramuscular injections.

Mike, age 8, is going home on medication after surgery. The nurse is preparing to review the discharge instructions with the mother. What basic information and/or instructions should be given to her to continue the drug therapy at home? Select all that apply. Ask her to refer to books on teaching children about medicines. description of the intended therapeutic drug effect generic and trade names of drugs schedule and duration of administration

generic and trade names of drugs schedule and duration of administration description of the intended therapeutic drug effect Explanation: A crucial step in administering pediatric drug therapy is educating the parents and other family members or caregivers, especially when the child returns home. Providing honest and detailed explanations and rationales helps reassure those caring for the child. The nurse should also provide age-appropriate explanations. Referring to books or imparting knowledge of the position papers will not help Mike's mother take care of her son at home.

A 3-year-old boy has developed otitis media and requires antibiotics. In order to increase the chance that the boy will take his prescribed medication, the nurse should: insert a central intravenous line. teach the boy about the fact that he will feel much better after he takes his medications. offer a choice between liquid and chewable medications, if possible. have the mother hold the child firmly and soothe him while the drugs are administered.

offer a choice between liquid and chewable medications, if possible. Explanation: Preschool-age children are often uncooperative during drug administration. Strategies for enlisting cooperation include offering choices (e.g., between liquid medicines or chewable tablets) when feasible. This is preferable to forcibly administering a medication. Teaching is unlikely to influence a 3-year-old child's reluctance. A central IV line would not be a preferred strategy if oral medications are available.

The clinical nurse educator who oversees the emergency department in a children's hospital has launched an awareness program aimed at reducing drug errors. What measure addresses the most common cause of incorrect doses in the care of infants and children? avoiding intravenous administration of drugs whenever possible having nurses check their math calculations with a colleague before administering a drug ensuring that a full assessment takes place no more than 30 minutes before giving a drug recording drug administration in both the nurse's notes and the medication administration record (MAR)

having nurses check their math calculations with a colleague before administering a drug Explanation: Of all the problems that may contribute to an incorrect dose, the most common involve errors in math during dosage calculation. Dosage calculation can involve several steps, and a mathematical error can occur at each step. Documentation in multiple locations, rigorous assessment, and avoidance of IV administration are not practices that appreciably reduce the potential for incorrect doses.

The charge nurse is assisting the new graduate nurse in administering eye drops to a child. The charge nurse would stop the new graduate if which action was observed? administers drops into conjunctival sac allows the child to sit up after blinking a few times positions the child supine on the bed holds the eyelids apart for about 30 seconds

holds the eyelids apart for about 30 seconds Explanation: To prevent the conjunctiva from drying, the nurse should not hold the eyelids apart any longer than necessary. Therefore, the charge nurse would need to stop the new nurse. It is best to use the supine position. Instill the correct number of drops into the conjunctiva of the lower lid. Allow the eyelid to close. Avoid placing the drops directly on the cornea because that can be painful. To prevent the conjunctiva from drying, do not hold the eyelids apart any longer than necessary. After the child has blinked 2 or 3 times, allow the child to sit up

The danger of fluid overload developing is a potential problem in the infant receiving an intravenous infusion. For which of the following would you observe? decreased blood pressure and swelling of the feet increased pulse rate and increased blood pressure increased pulse rate and decreased blood pressure decreased pulse rate and decreased blood pressure

increased pulse rate and increased blood pressure Explanation: An increased fluid load puts excessive strain on the circulatory system, increasing pulse rate and blood pressure.

A nurse understands that it is important to help a family adjust to a child's chronic health condition. This is best done by doing which of the following? making adjustments in care by doing ongoing interviews telling the family how they should cope telling the family that "it will get better with time" focusing primarily on the sick child

making adjustments in care by doing ongoing interviews Explanation: It is important to help the family adjust to the chronically ill child's condition. This is done best by doing an initial assessment and ongoing interviews. The nurse should never tell a family how to cope but instead give them suggestions about ways to cope. The nurse should encourage the caregivers to discuss the needs of the healthy siblings as well as the sick child. He or she should never tell a family that it will get better over time; doing so is inappropriate and can give false hope.

When caring for the child with a chronic condition, the nurse provides education to the parents: as problems arise. periodically during care. on an ongoing basis. prior to discharge.

on an ongoing basis. Explanation: Teaching parents about their child's chronic condition is not something that is done only once; rather, parent and family teaching should be an ongoing process. This education enhances the parents' ability to manage the child's chronic condition. Doing so is often easier for the parents when they feel knowledgeable about the condition, competent in the skills needed to care for the condition, aware of what symptoms indicate problems and which do not, and supported by the health care community should they have a problem.

A 5-year-old child who has recently been diagnosed with leukemia is never disciplined. The child's mother will feed the child although he is capable of feeding himself. She will not let him do anything for himself. This is an example of: gradual acceptance. rejection. denial. overprotection.

overprotection. Explanation: Several typical caregiver responses to chronic illness have been identified: overprotection, rejection, denial, and gradual acceptance. Caregivers responding with overprotection try to protect the child at all costs. They hover, which prevents the child from learning new skills, they fail to use discipline, and they use any means to prevent the child from experiencing any frustration.

Which characteristic best describes a condition that is considered a chronic illness? is present at birth or shortly thereafter progresses slowly and shows little change begins abruptly and subsides quickly causes lack of energy and strength

progresses slowly and shows little change Explanation: A chronic illness is a condition of long duration or one that progresses slowly, shows little change, and often interferes with daily functioning.

A single parent of a child with leukemia tells the nurse that exhaustion has set in and she would love the opportunity to have a day to just visit with a friend and relax. For what type of care could the nurse make a referral? respite care hospital care home health care acute care

respite care Explanation: Respite care is securing care for the ill child so that regular caregivers can have a period of rest and refreshment. It is often desperately needed but not readily available in many communities

Which educational topic is often overlooked when teaching an adolescent about living with a chronic condition? drinking alcohol drug activity sexuality smoking

sexuality Explanation: All aspects of an adolescent's development must be addressed when instructing on living with a chronic condition. Health care providers are typically comfortable with topics of smoking, drinking alcohol, and drugs but often uncomfortable talking about sex

A newborn is diagnosed with spina bifida. What initial reactions might the nurse expect to observe in the parents of the newborn? Select all that apply. elation shock acceptance disbelief denial

shock disbelief denial Explanation: When family caregivers learn of a child's diagnosis, their first reactions may be shock, disbelief, and denial. These reactions last for varied times, from days to months. The initial response may be of mourning for the "perfect" child lost, combined with guilt, blame, and rationalization.

A toddler is receiving oral antibiotic treatment for an ear infection. Before administering the drug, which factors must the nurse consider? Select all that apply. the child's blood sugar level the child's food and drug interactions the child's body surface area the child's weight

the child's body surface area the child's food and drug interactions the child's weight Explanation: A child's age, weight, body surface area, water content, and fat content must be considered when determining the proper dose of a drug. Food and drug interactions must also be considered, if appropriate. Other physiologic attributes, such as blood sugar level and blood pressure, do not affect the drug dosage for a child. Drug dosage is calculated for each child by means of mathematical formulas.

What is the most important reason for administering a medication at the correct time? to maintain the desired blood level of the medication to keep PRN medications on a schedule to prevent a missed dose of medication to follow facility policies regarding medication administration times to develop a process for medication administration in an effort to prevent errors

to maintain the desired blood level of the medication Explanation: Administering a drug at the correct time helps to maintain the desired blood level of the drug. When giving a PRN medication, always check the last time it was given and clarify how much has been given during the past 24 hours

A 12-month-old child weighing 11 lb has an order for gentamycin sulfate 13 mg IM q 36 hour. The pharmacy has 20 mg/2 ml on hand. How may milliliters would the infant receive, and what is the best site for the injection? 0.13 mg; vastus lateralis 1.3 ml; vastus lateralis 1.3 ml; deltoid 0.13 mg; ventrogluteal

1.3 ml; vastus lateralis Explanation: For IM injections in infants, the mandatory site for administration is the vastus lateralis muscle of the anterior thigh. Use the lateral aspect rather than the medial portion because this site is not as tender and should cause less pain. 0.13 mg is incorrect, and both ventrogluteal and deltoid are not sites used with the toddler

The nurse is preparing to administer a medication to a 5-year-old who weighs 35 pounds. The prescribed single dose is 1 to 2 mg/kg/day. Which is the appropriate dose range for this child? 70 to 140 mg 35 to 70 mg 8 to 16 mg 16 to 32 mg

16 to 32 mg Explanation: The nurse should convert the child's weight in pounds to kilograms by dividing the child's weight in pounds by 2.2 (35 pounds divided by 2.2 = 16 kg). The nurse would then multiply the child's weight in kilograms by 1 mg for the low end (16 kg × 1 mg = 16 mg) and then by 2 mg for the high end (16 kg × 2 mg = 32 mg).

A nurse is caring for a child who requires intravenous maintenance fluid. The child weighs 30 kg. Calculate the child's daily maintenance fluid requirement in milliliters. Record your answer using a whole number. for 24 hours. (10 x 100) + (10 x 50) + (10 x 20) = 1,700.

1700 Explanation: The child's daily intravenous fluid maintenance is 1,700 mL. The child requires 100 mL/kg for the first 10 kg, plus 50 mL/kg for the next 10 kg, plus 20 mL/kg for each kg more than 20 kg. This equals the number of milliliters required for 24 hours. (10 x 100) + (10 x 50) + (10 x 20) = 1,700.

The nurse is caring for a child who weighs 42 lb (19 kg). The medication prescribed for the child has a therapeutic dosage range of 33 mg/kg/day to 48 mg/kg/day. The medication prescribed is to be given 3 times per day. Which dosage would the nurse identify as being appropriate to administer to this child in one dose? 627 mg 62.7 mg 30.4 mg 250 mg

250 mg Explanation: Use the child's weight in kilograms. The low dose of this medication would be 19 kg × 33 mg/kg/day = 627 mg, divided by 3 times per day equals 209 mg per dose. The high dose of this medication would be 19 kg × 48 mg/kg/day = 912 mg/day divided by 3 times per day equals 304 mg per dose. Halfway between these two dosages (304 mg - 209 mg = 95 mg, 95 mg ÷ 2 = 47.5 mg), equates to a dose of 250 mg per dose being appropriate.

The nurse is preparing to administer an oral dose of metoclopramide to a 5-year-old child who weighs 40 pounds. The order reads metoclopramide 0.8 mg/kg/day to be given in 4 oral doses. How many milligrams would the nurse administer for each dose? 18.2 kg per dose 3.65 mg per dose 14.6 mg per dose 8 mg per dose

3.65 mg per dose Explanation: The pounds must be converted to milligrams first. 40 divided by 2.2 equals 18.2 kilograms. Then multiply 0.8 mg times 18.2 kg which equals 14.6 mg per day. Divide 14.6 mg by 4 since it is 4 times each day and you get 3.65 mg per dose. 8 mg is not correct. The pounds must first be converted to kilograms. 14.6 mg is not correct. This dose must be further divided by 4 since it is given 4 times each day. 18.2 mg is not correct. 18.2 is the answer when you convert 40 pounds to kilograms.

The nurse is preparing to administer an oral dose of metoclopramide to a 5-year-old child who weighs 40 lb (18.2 kg). The prescription reads metoclopramide 0.8 mg/kg/day to be given in 4 oral doses. How many milligrams of metoclopramide would the nurse give per dose? 8.00 mg per dose 18.20 kg per dose 14.60 mg per dose 3.65 mg per dose

3.65 mg per dose Explanation: To calculate the does, use the client's weight in kilograms. Multiply 0.8 mg by 18.2 kg, which equals 14.6 mg per day for the client's weight. Then, divide 14.6 mg by 4, the number of doses per day , to arrive at 3.65 mg per dose.

A pediatric client who weighs 33.4 kilograms is prescribed a medication in which the safe dose range is 15 to 20 mg/kg/day in q 12 hours divided doses. What is the highest single dose, in milligrams, that a nurse can administer in the safe dose range? Record your answer using a whole number.

334 Explanation: The highest dose is 20 mg × 33.4 kg = 668 mg/day. 668 mg ÷ 2 doses = 334 mg/dose

The nurse is preparing to administer oral ampicillin to a child who weighs 40 kg. The safe dose for children is 50 to 100 mg/kg/day divided in doses administered every 6 hours. What would be the low single safe dose and high single safe dose per day for this child? 500 to 1,000 mg per dose 100 to 500 mg per dose 1,000 to 5,000 mg per dose 50 to 100 mg per dose

500 to 1,000 mg per dose Explanation: To calculate the dosage, the nurse would set up a proportion to calculate the low dose as follows: 50 mg/1 kg = x mg/40 kg; solve for x by cross-multiplying: 1 × x = 50 × 40; x = 2,000 mg divided by 4 doses per day = 500 mg. Then calculate the high safe dose range using the following proportion: 100 mg/1 kg = x mg/40 kg; solve for x by cross-multiplying: 1 × x = 100 × 40; x = 4,000 mg divided by 4 doses per day = 1,000 mg.

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? 1,290 milligrams 1.3 milligrams 147 milligrams 587 milligrams

587 milligrams Explanation: The child's weight must first be converted to kilograms by dividing 86 by 2.2. The result is 39.1 kilograms. Next, the 39.1 kilograms must be multiplied by 15 milligrams. This answer is 587 milligrams.

A nurse is caring for a school-age child who is to receive long-term intravenous antibiotics at home for treatment of a bone infection. When discussing the options for intravenous access, which access route would the nurse include as being the likely choice? . A vascular access port in the left upper chest An intraosseous line placed in the left right leg A tunneled catheter inserted into the right upper chest A peripherally inserted central catheter in an antecubital space

A peripherally inserted central catheter in an antecubital space Explanation: Peripherally inserted central catheters or PICC lines are advantageous for home care because they can remain in place for up to 4 months without being changed. In a PICC line, a catheter is inserted into an arm vein and advanced until the tip rests in the superior vena cava. Drugs commonly administered by PICC lines are antibiotics. The child does not need a port or tunneled catheter implanted in the chest. An intraosseous line is not indicated for this child's medication therapy.

A 3-year-old child with asthma and a respiratory tract infection is prescribed an antibiotic and a bronchodilator. The nurse notes the following during assessment: oral temperature 100.2°F (37.9°C), respirations 52 breaths/minute, heart rate 90 beats/minute, O2 saturation 95% on room air. Which action will the nurse take first? Apply oxygen at 2 liters via a nasal cannula. Administer the bronchodilator via a nebulizer. Apply a cardiac monitor to the child. Give the antibiotic as prescribed.

Administer the bronchodilator via a nebulizer. Explanation: The nurse would first administer the bronchodilator to open the child's airway and facilitate breathing. Once the airway was open, the nurse could administer oxygen, if indicated. At this time, the child's saturation level is normal but it should be monitored. The nurse would then administer the antibiotic medication. The heart rate is within normal range for a child of this age (65 to 110 beats/minute); therefore, a cardiac monitor is not needed at this time

The nurse is preparing to administer the hepatitis B vaccine to a newborn shortly after birth. Which of the following would be most appropriate for the nurse to do? Administer the medication in the infant's vastus lateralis with a 25-gauge needle. Administer the medication in the dorsogluteal site using a 25-gauge needle. Administer the medication in the deltoid muscle with a 20-gauge needle. Administer the medication in the vastus lateralis using a 20-gauge needle.

Administer the medication in the infant's vastus lateralis with a 25-gauge needle. Explanation: The vastus lateralis site is a safe choice for IM injections in an infant. A 25-gauge needle is recommended for infants. The deltoid muscle is not a recommended IM site for infants. The dorsogluteal site should not be used until the child has been walking for 1 year.

The nurse is preparing to give a preschool-age client an oral medication. Which approach would be appropriate for the nurse use to gain the child's cooperation? Leave the medicine on the bedside stand; it can be taken independently. Ask the child if they want to take teh medication with juice or water. Compare the taste of the medicine to a candy bar. Offer to play a game with the child if the medicine is swallowed.

Ask the child if they want to take teh medication with juice or water. Explanation: The child should be offered choices to provide a sense of control. Asking if they want to drink water or juice with the medication would be the preferred approach to gain the child's cooperation. Medicine should never be compared to candy. The child might eat a fatal amount of the medicine when unattended. Offering to play a game is bribing the child and should not be done. The medicine should not be left at the bedside stand. The child might forget to take it and another child might swallow it.

The pediatric nurse is bringing the prescribed medication for a child but notes that the identification band is missing. The parents are at the bedside holding the child. What is the best method for identifying the child? Ask the child to tell you their name. Leave the medication at the bedside and get another identification band. Ask the parents to tell you the child's name and date of birth. Hold the medication, documenting in medication record as being held due to missing identification band.

Ask the parents to tell you the child's name and date of birth. Explanation: The parents are the best resource for finding out the child's legal name and date of birth, which can be compared to the medical record. The child may use a nickname or other name, which cannot be verified with the medical record. It is not safe to leave any medication at the bedside. It is appropriate to get another identification band once the child has been properly identified. Refusing to give the medication is not appropriate if the nurse is able to identify the child correctly

The nurse is preparing to administer phytonadione to a newborn. What would the nurse do next? Place the newborn in the prone position. Clean the newborn's thigh with alcohol. Calculate the dose using mg/kg formula. Confirm the newborn's blood type.

Clean the newborn's thigh with alcohol. Explanation: For IM injections in infants, the preferred site for administration is the vastus lateralis muscle of the anterior thigh. The newborn's blood type is irrelevant to this medication administration. The dose is either 0.5 or 1 mg, and it does not need to be calculated using the mg/kg formula. The newborn would need to be in the supine position to administer the medication in the vastus lateralis.

While caring for a child with cerebral palsy, the parents state, "We do not spend enough time with our other children. We really want to plan a vacation but have no one to care for this child." Which intervention would the nurse recommend? Request hospital admission. Hire a private nurse. Find a local babysitter. Contact respite care.

Contact respite care. Explanation: Respite care is designed to give caregivers much-needed rest and time. This is a resource for the family to use that is safe and financially appropriate. A babysitter may not be qualified to care for a child with cerebral palsy. Safety is the priority. Hospitals are not able to admit clients unless medically necessary. Hiring a private nurse would be expensive and could be difficult to find an appropriately educated nurse. The family would not be able to determine the qualifications of the nurse.

A nurse is preparing a dose of insulin to give Billy, an 11-year-old boy. Which of the following actions would be most appropriate for the nurse to do when giving this medication? Have another registered nurse witness the injection being given to the client. Double check the math calculations for the dosage. Ask the child if he has had any adverse reactions to insulin in the past. Double check the dose with another registered nurse before giving it.

Double check the dose with another registered nurse before giving it. Explanation: Insulin is a high alert medication; it has a high risk of causing harm when an error occurs. Therefore, it must be checked with another registered nurse before it is given. Insulin is typically ordered as specific units, so no calculations are needed. Insulin injections do not have to be witnessed. Insulin can cause adverse reactions but this is not the main concern with administration.

The nurse is teaching parents of a 12-year-old child how to administer otic medication. Which statement by the parent indicates a need for further education? "I will hold the dropper 0.5 in (1.25 cm) above the ear canal and be certain not to touch the ear with the dropper." "I will pull the outer ear down and back before administering the medication." "After removing the medication from the refrigerator, I need to roll it gently in my palms to warm it." "After administering the drops, I will ask my child to remain side-lying for several minutes."

I will pull the outer ear down and back before administering the medication." Explanation: The proper technique to instill ear drops in a child older than 3 years of age involves pulling the pinna up and back. Otic medication should not be administered if it is cold. Cold medication may cause discomfort and produce vomiting or vertigo in the child. If an otic medication must be refrigerated, it should be warmed in the palms of the hands. Proper otic administration technique involves holding the dropper 0.5 in (1.25 cm) above the ear canal and being careful not to touch the dropper to the ear to prevent contamination of the dropper with microorganisms. The child should remain in a side-lying (or supine) position for several minutes after administration.

A nurse is teaching the parent of a 4-year-old child with an ear infection how to administer ear drops. The nurse determines that the teaching was successful when the parent demonstrates which action? The parent keeps the affected ear facing up for about 5 minutes after the drops. The parent massages the area behind the ear after giving the ear drops. The parent pulls the pinna down and back to instill the ear drops. The parent applies petroleum jelly to the ear canal to prevent leaking of the drops.

The parent keeps the affected ear facing up for about 5 minutes after the drops. Explanation: When giving ear drops, the parent should pull the pinna up and back (for a child older than 3 years of age) to straighten the canal. After instilling the drops, the parent should gently massage the area in front of the ear and keep the child in a position with the affected ear up for 5 to 10 minutes. A cotton ball may be loosely inserted into the ear to prevent leakage of medication. Petroleum jelly should not be used.

A preschool-aged child has recently been diagnosed with a chronic condition. The nurse is assessing for evidence that the parents are accepting their child's condition. What finding indicates to the nurse that acceptance has occurred? The parents hover over the child even after medications have been given. The parents encourage the child to overcompensate for the condition. The parents take a common-sense approach to care. The parents do not include any discipline in the child's care.

The parents take a common-sense approach to care. Explanation: When the parents of a child with a chronic condition reach the stage where they accept the child's condition, they take a common-sense approach to the child's care. The parents encourage the setting of realistic goals for the child to achieve. These parents have gone through the stages of grief and have accepted their child's condition and incorporate the child into the family. Parents who encourage overcompensation for the condition are in the stage of denial. Parents who do not discipline and hover over the child are in the stage of overprotection.

An infant is to have a scalp-vein intravenous infusion begun. What is an advantage of this insertion site? Infiltration cannot occur with this insertion site. The child will not feel pain from the needle insertion. The scalp veins are easily visualized. Glucose is absorbed best from scalp veins.

The scalp veins are easily visualized. Explanation: Peripheral IVs can be inserted in neonates and infants. The scalp veins are easily visualized, being covered only by a thin layer of subcutaneous tissue. These veins do not have valves, so the device may be inserted in either direction, although the preference would be in the direction of blood flow. Unless the area has been numbed before the procedure, the child will feel the pain of insertion. Infiltration can occur at any site a peripheral catheter has been inserted. Glucose can be absorbed from any vein from which it is infusing.

A mother is told that her child will receive total parenteral nutrition. She asks the nurse what this means. The nurse bases her response on knowledge that total parenteral nutrition is: administration of Ringer's lactate through a peripheral IV line. administration of fluids, electrolytes, amino acids, lipids, dextrose, and minerals through an IV. nutrition through a nasogastric tube. daily IM injections of vitamins.

administration of fluids, electrolytes, amino acids, lipids, dextrose, and minerals through an IV. Explanation: Total parenteral nutrition is an IV fluid that contains dextrose, amino acids, lipids, electrolytes, vitamins, and minerals through an IV. A peripheral IV might be used short term, but in most cases the fluid will be administered through a central IV line. TPN is not administered IM or through a nasogastric tube, and it includes more nutrients that those contained in Ringer's lactate

The nurse is working to gain a preschooler's cooperation to swallow an oral medication. What would be the nurse's best approach? compare the taste of the medicine to a chocolate bar ask if the child would like to take the medicine in a cup or through an oral syringe leave the medicine on the night stand so the child can take it independently offer to play a game with the child if the child takes the medicine

ask if the child would like to take the medicine in a cup or through an oral syringe Explanation: The preschool age is when the child develops initiative. This is the sense that the child is helping. Thus, the nurse should allow the child to participate in the medication task. The instructions and choices need to be simple. The nurse can ask if the preschooler would like to take the medicine in a cup or through an oral syringe. Medicine never should be compared to candy or any other foods. Doing so can present a safety problem if the child gets into the medication cabinet at home thinking he or she is getting candy. Children cannot be depended on to take medicine without supervision, so leaving the medication on the night stand would not only be ineffective it would also be dangerous. Bribing is ineffective. A preschooler is not going to do a task he or she does not like and the medication is needed to make the child well. The nurse should be gentle but firm in the administration of the medication.

A medical/surgical nurse has been floated to the pediatric unit. Which action by the float nurse would require the pediatric nurse to intervene? asking the child his or her name prior to giving medications requesting the pediatric nurse to double-check calculations speaking to both the parents and child about medications scanning the child's barcode on the identification band

asking the child his or her name prior to giving medications Explanation: To prevent errors, the nurse should never ask children their names for identification. This action would require the pediatric nurse to intervenes. Instead, nurses must read or scan the bar code on clients' identification arm bands and compare them with the medication sheet or electronic record. It is important to include both the parents and child in teaching about a medication. Calculating pediatric doses is not something medical/surgical nurses do on a regular basis, so it would be appropriate for the float nurse to have a pediatric nurse double-check the calculations.

A 4-year-old child is admitted to the hospital for surgery. Before the nurse administers medicine, the best way to identify the child would be to: ask the child to state his or her name. read the child's armband. call the child's name and see if he or she answers. tell the child to state his or her nickname.

read the child's armband. Explanation: A child may answer to the wrong name or deny his or her identity to avoid an unpleasant situation or if scared of the unknown. If the child is avoiding the situation he or she may fail to answer. Using the child's nickname is okay in conversation but it is not a legal identification of the child. To verify the correct identity the nurse should verify the child's armband and the correct name with the child's caregiver. Bar code scanning the child's armband would also be a correct method of identification.

Parents question the necessity of moving their preschooler from her room to another place to insert her IV line. The nurse explains: the playroom will be used to start the IV because of all the available distractions. the importance of avoiding unpleasant experiences in the child's room and bed in order for both to remain safe places. movement to the treatment room is necessary to provide the required equipment. the child's room and bed are not ideal since lighting and privacy are insufficient.

the importance of avoiding unpleasant experiences in the child's room and bed in order for both to remain safe places. Explanation: The child's room and bed should be as nonthreatening and safe as possible. The child needs to feel secure in what is her space in an unfamiliar environment. The playroom also needs to remain a place of pleasure and security. Procedures are not done there. Distraction can be provided in places other than the playroom. The treatment room does have many supplies, and the hospital room lighting may not be optimal, but those are not the basic reasons why the child's room will not be used as the IV start location.

After administering eye drops to a child, the nurse applies gentle pressure to the inside corner of the eye at the nose for which reason? to enhance systemic absorption to promote dispersion over the cornea to ensure the medication stays in the eye to stabilize the eyelid

to ensure the medication stays in the eye Explanation: Punctal occlusion, or gentle pressure to the inside corner of the eye at the nose, helps to slow systemic absorption and ensure that the medication stays in the eye. Having the head lower than the body aids in dispersing the medication over the cornea. Placing the heel of the hand on the child's forehead and then retracting the lower lid helps to stabilize it.

A child with a seizure disorder is prescribed valproic acid and is refusing to swallow the capsule. What is the best way for the nurse to administer the medication? Offer a reward for taking the medication. Open the capsule and place in a small amount of applesauce. Let the parent administer the medication. Ask the pharmacist if another generic comes in a smaller tablet.

Open the capsule and place in a small amount of applesauce. Explanation: Valproic acid comes in several different forms. A common form is in a capsule containing sprinkles of the drug. The capsules can be opened and the sprinkles placed in a small amount of applesauce or even yogurt. Some of the oral tablets come in forms that can be crushed. If the medication can be crushed, the nurse can place the crushed medication in a small amount of applesauce and offer the applesauce to the child. Applesauce makes the ingestion more palatable. The nurse should not mix the medication with the entire carton of applesauce, because the child may not eat the entire amount and, therefore, not get the correct dose of the medication. If there is a difficulty with the medication administration, the nurse can discuss with the pharmacist to see if the medication comes in a liquid form. Children always enjoy rewards, so this could be an option for the nurse to use to get the child to take the medication. Parents are always important to assist in medication administration, but it is not the parent's responsibility to administer the medication.

The nurse caring for a 6-year-old enters the room to administer an oral medication in the form of a pill. The dad at the bedside looks at the pill and tells the nurse that his daughter has a hard time swallowing pills. What is the best response by the nurse? Ask the child to try swallowing the pill and offer a choice of drinks to take with it. Request that the physician prescribe the medication in liquid form. Crush the pill and add it to applesauce. Call the pharmacy and ask if the pill can be crushed.

Call the pharmacy and ask if the pill can be crushed. Explanation: The father is the best source of knowledge on medication administration for the child. The pharmacy should be called to determine if the pill might be crushed. Asking the child to try swallowing the pill disregards the information the father has just given. Requesting that the physician order the medication in liquid form is not necessary at this point.

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? 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 supine in bed, and squirt the medication on the tongue toward the cheek. 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. Place the medication in a bottle with a small amount of juice, then feed the infant the bottle 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. Explanation: Proper medication administration for an infant includes the following: Position the infant upright, present a pleasant- or neutral-tasting substance to ensure that the child is awake and swallowing, give the medication slowly enough to allow the child to swallow and prevent any risk of aspirating, and give a pleasant-tasting "chaser." An infant should not be placed supine since this would increase the risk of aspiration. Medications should not be placed in a client's staple food to avoid an aversion to the food in the future.

What is the best response by the nurse when a 13-year-old client with a chronic condition expresses that she does not "like being different from her peers"? reassurance that one day she will be like her peers allowing the child to participate in her care active listening while discussing with the child her perception of her body image discussing the comment with the interdisciplinary team

active listening while discussing with the child her perception of her body image Explanation: One of the first interventions when caring for an older child or adolescent who has a chronic condition is determining how they see their condition and its impact on their life. Active listening will allow the nurse to determine ways to teach and assist this child's needs. False reassurance is not helpful and may be misleading, allowing the child to participate in her care enhances self-esteem but may not specifically address body image concerns, and discussing this finding with an interdisciplinary team does not benefit the client specifically.

The parents of a child with a chronic illness are seeking educational opportunities for their child. What factor(s) will the nurse advise the parents to explore to help the parents with their goal? Select all that apply. child's capability for learning in a standard classroom type of classroom the child will be placed in whether the child requires treatments during the school day whether the child would benefit from a home education program accessibility accommodations available at the school

whether the child would benefit from a home education program accessibility accommodations available at the school type of classroom the child will be placed in whether the child requires treatments during the school day Explanation: The parents of a child with chronic illness have many difficult decisions when it comes to meeting the educational needs of the child. Included in these decisions is the availability of appropriate educational facilities. The parents must decide between in-person school or home school, depending on the child's needs. If the parent chooses a school building, the parents will need to determine whether this building has the necessary accessibility accommodations. When meeting with school personnel, the parents should feel the child would be accepted; check whether the school nurse will be available to administer medications and provide treatments; and ask whether the child's needs would result in the child being placed in an open or a segregated classroom. The nurse would discuss with the parents that all children are capable of learning, but their child's learning may need to be adapted and the child does not need to learn in a standard classroom.