N138 Chp 22 Peds variations of Nrsng Interventions

The nurse is preparing a plan to teach a mother how to administer 1½ teaspoons of medicine to her 6-month-old infant. What does the nurse teach the parents to use, based on knowledge of administering pediatric medications? 1 Regular silverware teaspoon 2 Household measuring spoon 3 Paper cup marked in 5-ml increments 4 Plastic syringe (without needle) calibrated in milliliters

4 A plastic calibrated syringe without a needle offers the most accurate measurement for medication administration in the infant. The nurse should teach the mother to give the infant 7.5 ml of the medication. Household measuring spoons may be used if other, more precise devices are not available, but they are not the preferred method of medication administration for an infant. Regular silverware teaspoons are not acceptable for medication administration because household teaspoons vary greatly in size. A paper cup marked in 5-ml increments will not help the mother measure the additional 2.5 ml that is needed for this infant's required dosage, and its use would therefore limit the accuracy of the dosage. Test-Taking Tip: Note the number of questions and the total time allotted for the test to calculate the times at which you should be halfway and three-quarters finished with the test. Look at the clock only every 10 minutes or so.

A 24-hour urine collection is ordered for a 2-year-old child. What does the nurse understand about this procedure? 1 That the collection period begins and ends with a full bladder 2 That collection bags are required for infants and older children 3 That the collection period begins and ends with an empty bladder 4 That all urine voided in the 24 hours is saved in a container and left at room temperature

The nurse understands that a 24-hour urine collection begins and ends with an empty bladder (not a full one). Collection bags are required for infants and young children; older children and adolescents do not need collection bags. All urine voided during the 24 hours is saved in a container and placed on ice, not left at room temperature.

A 10-year-old child requires daily medications for a chronic illness. The mother tells the nurse that she is always nagging the child to take the medicine before school. What is the most appropriate nursing intervention to promote the child's compliance? 1 Establish a contract with the child, including rewards. 2 Suggest time-outs when the child forgets her medicine. 3 Discuss with the child's mother the damaging effects of nagging. 4 Ask the child to bring her medicine containers to each appointment so that the pills can be counted.

1 For school-age children, behavior contracting with desirable rewards is an effective method of encouraging compliance. Any form of negative consequences, such as time-outs, should only be used if the behavioral contracting is not successful. Although nagging is not an effective strategy, the nurse needs to assist the mother in problem solving. The technique of counting pills may be tried if the contracting is not successful, but it sends a punitive signal to the child that may make the situation worse.

What intervention by the nurse is appropriate when a medical procedure is being performed for an infant? 1 Keep the parent in the infant's line of vision. 2 Perform the procedures in the infant's bed. 3 Avoid familiar objects around the infant during the procedure. 4 Be firm and approach the infant directly.

1 The nurse must ensure that the parents are in the line of the infant's vision at all times to provide a feeling of security. It is preferable to perform procedures, especially painful ones, in a different room away from the infant's bed, which is considered to be a safe place for the infant. Older infants may associate objects, places, or persons with the experience and may resist the sight of them. A familiar object or toy may be placed next to the child if the parents are not present with the infant. The nurse must be gentle in the approach toward the infant so that the infant does not feel threatened.

The nurse is asked to administer an intramuscular (IM) injection to a child. Which action by the nurse will prevent tissue shearing and provide less discomfort to the child during the procedure? 1 The nurse inserts the needle at a 90-degree angle. 2 The nurse uses a previously used injection site. 3 The nurse uses a filter needle to withdraw the medication. 4 The nurse administers the injection slowly.

1 When a needle is inserted straight at an angle of 90 degrees, tissue shearing is prevented and discomfort to the child is decreased. Using the same site for IM injections repeatedly causes fibrosis of the muscle. A filter needle is used to withdraw medications to trap any glass particles of the ampule that may have fallen into the medication. The nurse administers the injection quickly to avoid prolonging the stressful experience.

What is the best action for the nurse to take to minimize the risk of aspiration when administering a liquid medication to a crying 8-month-old infant? 1 Keeping the child upright with the nasal passages blocked for a minute after administration 2 Administering the medication with an oral syringe placed along the side of the infant's tongue 3 Mixing the medication with the infant's regular formula or juice and administering it by bottle 4 Administering the medication with a cup as rapidly as possible with the infant securely restrained

2 Administer the medication with an oral syringe placed along the side of the infant's tongue allows the contents to be administered slowly in small amounts. The child is able to swallow between deposits of the medication. Holding the child's nasal passages will increase the risk of aspiration. The medication should be mixed with only a small amount of food or liquid. If the child does not finish drinking or eating, it will be difficult to determine how much medication was consumed. Essential foods should also not be used. Medications should be given slowly to avoid aspiration.

The nurse is caring for a preterm infant born at 36 weeks with a nasogastric tube. What is the procedure for administering more than one medication at the same time? 1 Clamping the tube for 30 seconds between medications 2 Flushing the tube between medications with clear water 3 Pushing the medications together through the nasogastric tube 4 Checking for correct placement of the nasogastric tube between medications

2 The procedure for administering more than one medication at the same time through a nasogastric tube calls for the tube to be flushed with clear water after each medication. Clamping the tube for 30 seconds between medications is not indicated or necessary. Medications should not be pushed together through the nasogastric tube. A check for correct placement of the tube should be performed before the first medication is administered, not between medications.

The nurse is giving discharge instructions to the parent of an 8-month-old infant who is receiving a liquid medication. How should the nurse to teach the parent to measure liquid medicine to achieve the most accurate measurement? 1 Use a teaspoon measuring device intended for cooking. 2 Use a household measuring spoon to portion out the dose. 3 A regular silverware teaspoon may be used to measure the dose. 4 Use a plastic syringe (without the needle) calibrated in teaspoons/milliliters.

4 A plastic syringe calibrated in teaspoons/milliliters, minus the needle, offers the most accurate measurement. A teaspoon measuring device used for cooking is not accurate because it can vary depending on the viscosity of the medication and how the spoon is filled. A household measuring spoon may be used if other, more precise devices are not available, but the dose could vary. A dinner utensil is not acceptable because household teaspoons vary in size.

The nursing instructor is teaching a group of students about safety measures for children in a hospital setting. Which statement by a student indicates effective learning? 1 Pacifiers should be attached to the infant's neck with a string. 2 Baby walkers should be used to prevent falls and burns. 3 Pillows should be placed in the crib while the infant is sleeping. 4 Latex balloons pose a serious threat to children of all ages.

4 Latex balloons pose a serious threat to children of all ages. If the balloon breaks, the child may put a piece of the latex in the mouth, which may cause choking. Pacifiers are not attached to the infant's neck with a string, because this may cause strangulation. Baby walkers are not used, because they provide access to hazards, leading to fire and burns. Pillows are not placed in the crib while the infant is sleeping, because they may increase the risk for suffocation.

What play activity by the nurse helps to prevent postoperative respiratory tract infection in the child? 1 Providing ice pops using the child's favorite juice 2 Squirting water into the child's mouth with a syringe 3 Encouraging the child to climb the wall with the fingers 4 Having a blowing contest with pieces of paper

4 The child is encouraged to use the incentive spirometer for respiratory movement to prevent pneumonia. The nurse can accomplish this task by involving the child in games such as blowing pieces of paper or bubbles. The child is given ice pops or allowed to squirt water into the mouth to ensure adequate fluid intake. The child playfully climbs the wall with the fingers to perform range-of-motion exercises. STUDY TIP: A word of warning: do not expect to achieve the maximum benefits of this review tool by cramming a few days before the examination. It doesn't work! Instead, organize planned study sessions in an environment that you find relaxing, free of stress, and supportive of the learning process.

The nurse is conducting preoperative teaching with a child and the parents. The parents say that the child "is dreading the shot before surgery." On which fact should the nurse's response be based? 1 Preanesthetic medication can only be given intramuscularly. 2 The child will have no memory of the injection because of amnesia. 3 In children the intramuscular route is safer than the intravenous route. 4 Preanesthetic medication should be "atraumatic," administered through the oral, existing intravenous, or rectal route.

4 The necessity of premedication is being investigated. If necessary, numerous drug regimens and routes exist; the route is not limited to the intramuscular (IM) route. Preanesthetic medicines can be given by way of a variety of routes other than IM. The intravenous route is preferable to the IM route for premedication. The muscle may be sore after the injection. Therefore the child may have a memory and telling the child otherwise will create distrust between the nurse and the child or family. Test-Taking Tip: Pace yourself while taking a quiz or exam. Read the entire question and all answer choices before answering the question. Do not assume that you know what the question is asking without reading it entirely.

The nurse is caring for a child who suffers from quadriplegia. What nursing intervention promotes tissue integrity for this patient? 1 Avoiding the use of pressure-reduction devices on the bed 2 Massaging the reddened bony prominences to prevent tissue damage 3 Using a lot of tape and adhesives to make sure that bandages adhere firmly to the skin 4 Using the drawsheet to move the child onto a stretcher to reduce friction and shearing injuries

4 Using a drawsheet to move the child onto a gurney helps reduce friction and shearing injuries. Pressure-reduction devices should be incorporated into the child's care instead of avoided. One should never massage a reddened bony prominence, because deep tissue damage could result. Using a lot of tape and adhesives promotes tissue breakdown rather than tissue integrity.