OB/PEDS (Pre-Quiz) 35 & 36
The nurse is listing physiologic indicators of pain in children while teaching a pain management class for peers. Which of the indicators will be included? (Select all that apply.)
Change in blood pressure Oxygen saturation level Palmar sweating
The nurse is caring for a child with a nasogastric tube that has been in place for several days. It is time to administer the liquid feeding. What is the priority nursing action?
Check the length of the tube extending from the nose against the measurement recorded when the tube was placed.
The nurse is caring for a 7-year-old with a low-profile gastrostomy tube placed 6 months ago. Which is the priority intervention to prevent irritation of the skin at the insertion site?
Cleaning the surrounding skin with soap and water daily plus keeping the area dry
The nurse is preparing to administer medication to a 5-month-old client. The nurse is aware that at least 2 different client identifiers must be used. Which identifiers could the nurse use? (Select all that apply.)
Client's hospital ID number Client's full name Client's birthday
The nurse is assessing the abdomen of a preschooler admitted for lower right quadrant pain. Which questions or requests are appropriate to use with this child? (Select all that apply.)
"Choose the face that shows how you feel now" (FACES pain rating scale). "Touch the spot on your tummy where it hurts."
A nurse is caring for a child preparing to undergo a dressing change. Which statement by the parent lets the nurse know that the child's pain experience is at risk of being intensified?
"I hope that you will be a brave child and not cry."
A child is being discharged from the hospital and the nurse has completed discharge teaching regarding prescribed liquid medications. Which comments by the parent demonstrates understanding of discharge instructions for safe medication administration? (Select all that apply.)
"I will be sure to not give too much of the liquid medication at one time." "I need to make sure to use the medicine dropper the pharmacy gives me instead of the syringe I use for my B12 injections." "I shouldn't use a liquid dropper from my kitchen because it may be a different measurement than one from the pharmacy."
The nurse has finished completing a client education program for parents on proper medication administration to children. Which statement by a parent would indicate a need for further education?
"I will put my child's pill in a small amount of applesauce to help her learn now to swallow it."
The nurse is preparing a 6-year-old child for a venipuncture. The child appears anxious and is crying. How can the nurse foster feelings of control to help minimize the child's anxiety about the procedure?
"Pick your favorite Band-Aid and show me which arm to use."
The student nurse is preparing a presentation on ways to prevent medication errors in children. What information should the student include? (Select all that apply.)
-Verify orders for dosages that are unusually large or small. -Use 2 client identifiers prior to administering medications. -Double-check medication calculations prior to administration. -Utilize the Joint Commission's "Do Not Use" abbreviation list.
A child weighs 18 lb. The nurse is making sure the intravenous (IV) infusion is flowing at the correct rate. After determining fluid requirements for this child for a 24-hour period, the nurse should be sure that the IV is infusing at how many milliliters per hour?
34
A child needs a peripheral IV start as well as a venous blood sample for a laboratory test. The nurse will take what action?
Coordinate placing the peripheral IV and the lab blood draw.
A toddler requires 1.5 mL (.05 oz) of an antibiotic given intramuscularly (IM). How will the nurse administer this medication?
Divide the dose. Administer 0.75 mL (0.25 oz) IM in each vastus lateralis.
When administering parenteral or epidural opioids, the nurse should always have ready access to which medication?
Naloxone
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 angle into the elevated tissue of the upper arm
Parents are to bring their kindergarten child to the outpatient department for a venous blood sample. They have EMLA cream to apply at home prior to the procedure and have been shown two areas on the child's arms where they should place the cream. Transportation time is 15 minutes. Their appointment is for 2:45 PM At what time should the parents apply the cream and occlusive dressings to both arms?
Between 1:15 PM and 1:45 PM
The adolescent receiving morphine IV for pain control needs which included in the nursing care plan? (Select all that apply.)
Naloxone readily available Monitoring for itching Stand-by assistance when using the bathroom
The nurse is administering total parenteral nutrition (TPN) to a pediatric client. How often should the nurse monitor the child's blood glucose level during the initial phase of the infusion?
Every 4 to 6 hours
The nurse administers an antipyretic rectal suppository. The child has a bowel movement 15 minutes later. What is the appropriate nursing action?
Examine the stool for the presence of the suppository.
The nurse is providing postsurgical care for a 4-year-old child following hernia repair. Before surgery, the nurse taught the child to use the poker chip tool to rate pain. When assessing the child's postsurgical pain, the child refuses to touch the chips and clings to the parent. How should the nurse respond?
Give the parent the FACES pain rating scale to use with the child.
The nurse is assessing a child who is receiving TPN. The nurse determines the TPN bag was hung 24 hours ago. What initial action by the nurse is indicated?
Hang a new bag of TPN.
A family the nurse is working with administers cycled total parenteral nutrition (TPN) over a 12-hour period at night to free their teenager for activities during the day. In teaching this family, what areas would the nurse stress? (Select all that apply.)
Inspecting the insertion site of the catheter regularly Administering the solution at half-rate during the first and last hour of the infusion
The nurse wishes to reassure a 3-year-old child that there will be no discomfort when the child's peripheral IV site is examined. The nurse will use which words? (Select all that apply.)
No owie No hurt No boo-boo
An aunt at the bedside of a 7-year-old holds the child's hand and gently traces her fingers up and down the child's arm while talking softly about pleasant experiences on the grandparents' farm. This relative is using what technique to reduce pain? (Select all that apply.)
Nonpharmacologic management Relaxation Behavioral-cognitive strategy
When preparing to administer medication to an infant, the nurse should utilize which device?
Oral syringe without a needle
The nurse realizes that many factors influence a child's pain experience. Which pain scale may be most appropriate to use with the African American 6-year-old?
Oucher pain rating scale
The emergency department nurse is reviewing the medical record of a recently admitted infant and notes that the child's pain score is 14. The nurse realizes that the infant was assessed using which pain scale?
Riley Infant Pain Scale
The nurse is preparing a female toddler for the repair of an eyebrow laceration. The child is most likely to demonstrate which response in anticipation of the procedure?
Scream and cling tightly to the parent.
The nurse is about to assess pain in the child and will use the QUESTT acronym as a guide to objective and subjective data collection. This acronym stands for: (Select all that apply.)
Take action. Question the child.
A 10-year-old child with cerebral palsy needed orthopedic surgery and casting for tendon lengthening. The child returned from surgery with a patient-controlled analgesia (PCA) pump but is unable to use the hand control due to limited dexterity in the upper extremities. Which actions should the nurse take? (Select all that apply.)
Teach the parents the use of the pump and have them push the button to administer additional medication when needed. Administer bolus doses using the PCA pump (push the button) when assessment indicates the need.
The nurse is mentoring a newly graduated nurse on the pediatric unit. Which action by the new nurse requires further instruction when preparing an intramuscular injection for a 6-month-old? (Select all that apply.)
The nurse prepares to administer 0.7 mL of solution using one injection The nurse prepares to inject the medication into the ventrogluteal site
A preschooler who is receiving gastrostomy feedings occasionally vomits following a feeding. When the parent describes the feeding process, what does the nurse note as the likely cause of the vomiting?
The parent does not check gastric residual prior to feedings.
The nurse is monitoring a student who is administering a tablet to 4-year-old child. Which action by the student nurse requires further instruction by the nurse?
The student nurse prepares to mix the whole tablet in yogurt for administration. The student nurse prepares to crush the tablet and mix it in milk for administration. The student nurse prepares to administer the tablet to the child with juice.
The nurse is preparing to administer a vaccine to a 6-month-old child. The medication is to be given intramuscularly. The nurse is correct in choosing which administration site?
Vastus lateralis site
Immediately following administering a medication by enteral tube, the nurse will:
flush the tube with water.
The nurse is preparing to administer an antibiotic for a severe respiratory infection to a 5-year-old child. The child asks the nurse why he is getting this medication. What is the best response by the nurse?
"The medicine will help you feel better so that you can go home soon."
The nurse has provided teaching of nonpharmacologic pain management to the parents of a 3 year-old child experiencing postoperative pain. Which comments by the parents indicate that the teaching was effective? (Select all that apply.)
"I'm not sure if I am imagining it, but I think my child seems to be in less pain when I rock her." "I try to remind our child to think about our dog at home. Our dog is like a big cuddle toy to our child." "One of the nurses blows bubbles with our child every time they are preparing to perform a procedure, then allows our child to do the same during the procedure. It really helps." "My child seems to cry a lot less with medical procedures if we are reading a book together."
The parent of a child who just had abdominal surgery holds the child's hand and smoothes the child's hair. When the nurse appears to administer a scheduled analgesic, the parent states believing the child has been in pain the last hour or more. The nurse's best response is:
"Please tell me or any of the nurses when you believe the child is in pain."
A parent believes the 2-year-old child is frightened by seeing an intramuscular (IM) medication injected into the child's thigh and requests that the child's "butt" be used. What will be the nurse's response?
"The muscle in your child's butt is not well enough developed to receive this injection until the child has walked for 1 year."
The nurse is providing family education for the administration of ibuprofen. Which response indicates a need for further teaching?
"This can be taken with other medications we have at home that didn't require a prescription."
A child with Down syndrome has had surgery and experiences periodic pain. The child is 13-years-old but functions much like an 8-year-old. Which pain scales may be appropriate to use with this child? (Select all that apply.)
Poker chip tool FACES pain rating scale Oucher pain rating scale
The 2½-month-old infant needs a capillary blood specimen obtained. In addition to having the parent hold the infant, what can the nurse do to comfort the child? (Select all that apply.)
Provide a pacifier for the child. Give the baby a small amount of sucrose just prior to the procedure.
Included in the nursing care plan for the child receiving total parenteral nutrition (TPN) will be which intervention?
Regularly monitoring the child's blood glucose
An 11-year-old child is lying quietly in bed watching a DVD. This is the child's first postoperative day following open reduction of an ankle fracture. One nurse concludes the child does not need his PRN pain medication; another nurse disagrees. Which of the possibilities described is likely to be true? (Select all that apply.)
The 11-year-old is using the DVD to withdraw from discomfort and is lying still to avoid movement, which exacerbates the pain. The child may be concerned about getting a "shot" and is avoiding the display of pain behaviors.
The nurse is assessing the behavioral indicators of a 9-month-old to determine the child's pain level. Which description would be commonly associated with a pain response?
The child has an angry facial expression with the eyes open.
A 12-year-old child needs a lumbar puncture to collect cerebral spinal fluid for laboratory exam plus injection of medication into the central nervous system. The child expresses great fear of the procedure because of anticipated pain and the inability to hold still. The nurse contacts the healthcare provider to make which suggestion?T
The use of conscious sedation for the lumbar puncture.
The nurse is caring for a child with appendicitis. The nurse understands that this child is experiencing what type(s) of pain? (Select all that apply.)
Visceral pain Acute pain
The nurse is testing the pH of contents aspirated from a gavage feeding tube to confirm placement. Which finding indicates likely intestinal placement?
pH 7.0
A parent must administer a medication in syrup form to a 2-month-old infant. The nurse suggests:
placing the medicine in an empty nipple without an attached bottle.
