Nurs 2864 Chapters 31 and 39
What type of enema is the nurse most likely to use for a child?
An isotonic solution
The parents of a 7-month-old infant report to the nurse that the solid food they feed to the baby passes through the gastrointestinal tract unchanged. Which response of the nurse would help to relieve the parent's anxiety?
"It is a normal finding at this age."
When is bronchial (postural) drainage generally performed?
Before meals and at bedtime
The nurse advises the parents of a 2-year-old child to vaccinate their child with the influenza vaccine (inactivated influenza vaccine [IIV]). The child's parents ask the nurse, "My child had the same vaccine last year. Why does my child need another one?" Which response should the nurse give to the child's parent?
"Different strains of influenza are used to manufacture the vaccine each year."
The parent of a 12-month-old infant says to the nurse, "He pushes the teaspoon right out of my hand when I feed him. I can't let him feed himself; he makes too much of a mess." What is the nurse's best response?
"Feeding himself will help foster his growth and development. Perhaps we can discuss ways to make the messes more tolerable."
The nursing instructor is teaching a group of students about the use of enemas in children. The instructor says, "We usually do not use Fleet enemas for children." What statement by the student indicates a need for additional teaching?
"They are hypotonic."
The nurse is preparing a plan to teach a mother how to administer 1.5 teaspoons of medicine to her 6-month-old child. What should the nurse recommend using?
A plastic syringe (without needle) calibrated in milliliters
The nurse finds that a patient has developed tachycardia and tachypnea after administration of a muscle relaxant. What is an appropriate nursing action?
Administer dantrolene sodium intravenously.
Which antipyretic is associated with Reye syndrome in children?
Aspirin (Bayer)
Apnea of infancy has been diagnosed in an infant who will soon be discharged with home monitoring. When teaching the parents about the infant's care, what is the most important information the nurse should include in the discharge teaching plan?
Cardiopulmonary resuscitation (CPR)
The nurse is administering an antipyretic medication to a child with a high fever. What action does the nurse take in the first hour after giving the medication?
Check the temperature again.
The nurse administers isoflurane (Forane) to a child for pain relief. What complication does the nurse anticipate in the child?
Decreased blood pressure
The most appropriate recommendation for relief of teething pain is to instruct the parents to do what?
Give child a cold teething ring to relieve inflammation
The nurse observes erythema, pain, and edema at a child's intravenous (IV) site with streaking along the vein. What should the nurse do first?
Immediately stop the infusion.
What is an important consideration for the child receiving intravenous (IV) therapy?
Infiltration is hard to detect.
Several types of long-term central venous access devices are used. What is a benefit of using an implanted port (e.g., Port-a-Cath)?
It does not need to limit regular physical activity, including swimming.
A mother observes that her 7-month-old infant bears full weight on the feet when held in a standing position. What is the reason for this?
It indicates that the child's growth and development is normal.
What is the best explanation for why pulse oximetry is used on young children?
It is noninvasive.
Which activity of a 10-month-old infant indicates the development of object permanence?
Looking for a hidden object that the infant had seen earlier
A 10-year-old patient is scheduled for a minor surgery of the ankle. The patient's parents are divorced. What is an important consideration for this patient while obtaining consent?
Only the parent with legal custody is required to give consent.
The nurse needs to take the blood pressure of a preschool boy for the first time. Which action is best in gaining his cooperation?
Permit him to handle equipment and see the dial move before putting the cuff in place.
What is the most important complication associated with the use of peripheral venous catheters?
Phlebitis
The nurse is doing preoperative teaching with a child and his parents. The parents say that he is "dreading the shot" for premedication. What should the nurse's response be based on?
Preanesthetic medication should be atraumatic, using oral, existing intravenous, or rectal routes.
What does the nurse keep in mind while administering an enema to a child?
The buttocks of the child should be held together briefly.
What is a common postoperative complication of anesthesia?
Respiratory tract infections
The parents of a 6-month-old infant report to the nurse that the infant is not sleeping properly and is refusing to eat solid foods. The infant is also biting on hard objects and sucking his fingers continuously. What should the nurse interpret from these symptoms?
The child shows signs of teething.
A parent asks the nurse in the well-baby clinic, "Which toy should be given to the 3-month-old infant?" Which toy does the nurse suggest to the infant's parent?
Soft stuffed toy
Which activity does the nurse expect to observe in a 4-month-old infant?
The infant grasps an object by using both hands.
During the assessment of a 12-month-old infant, the nurse finds that the infant's head and chest circumference are equal, the length of the infant has increased by 50% since birth, and the weight is triple that of the birth weight. What does the nurse interpret from these findings?
The infant has normal development.
While assessing an infant, the nurse notices a typical bald spot, a symmetric distortion of the skull, and torticollis. What should the nurse interpret from this assessment?
The infant has positional plagiocephaly.
The nurse is caring for a 10-year-old patient after surgery. The nurse gives the patient an inhaled anesthetic for pain relief. What is an important consideration for the patient?
The patient may develop tachycardia.
The nurse is caring for a teenager scheduled for surgery. What criteria does the nurse use to obtain valid consent from the patient? Select all that apply.
The patient should act voluntarily. The patient should be well-informed. The patient should be over the age of majority.
The relative of a child receiving oxygen therapy brings the child a remote-controlled airplane as a gift. What safety risk does the toy present to the patient?
The toy can cause fire.
The nurse educator instructs a nursing student that according to Erikson, infancy is concerned with acquiring a sense of what?
Trust
The nurse is caring for an infant with a tracheostomy when accidental decannulation occurs. The nurse is unable to reinsert the tube. What should be the next action by the nurse?
Trying to insert a smaller-size tube
The health care provider has prescribed a liquid iron supplement for an infant with iron deficiency. What advice does the nurse give to the parents to prevent the infant's teeth from staining from the liquid iron supplement?
Use a dropper toward the back of the mouth
What action does the nurse take to prevent ventilator-associated pneumonia for the patient receiving mechanical ventilation?
Use aggressive hand hygiene.
The nurse is educating new parents about the prevention of sudden infant death syndrome (SIDS). What position does the nurse tell the parents is the best sleeping position for their infant?
supine
